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Name: <br />Street Address: <br />City, State, ZIP: <br />Home Phone: <br />Email: <br />Property Owner Information <br />(If different than Applicant) <br />Work Phone: <br />Fax Number: <br />Please provide a detailed description of your request and attached a copy of a scaled site plan <br />‘ KM' oC Lan klOH ti oOk 'a\ktcnct A \Ackiao\,ovA,\%okist, kuckd moo a docliov;z. <br />lioos r \'(jo sat w;rkh cwt" 4c3orfts.oko u aOS WwilUt ‘s q male rintAVISn <br />\2) L85119 iea�5 alAl ,Sul'te4 �s te �e�i 1 C ?OJY\ i Ly:.5 1'L years olal \v\t1 <br />K a Cznit VITTOTTan \\ 1-16S W InO,nth5 a1�, FAiih ‘s a �ema1e gameran�,� 3 ��min}hs oldl ; hone are t��eAerec)c Shed ls IY\ hovsi 3 NV, <br />doa5 .4 Wfctink 460 ar• 4.-netall v�Ipgr dp S {lpa} acC 1e} u�.�ldC �o <br />� kXI tY Vrvas� CO� <br />A "Land Use Sign" will be placed on the Subject Property to allow Ramsey Residents the <br />opportunity to obtain information about your request. <br />Applicant Signature <br />Printed Name <br />Title <br />Date <br />tk-a\R YdAm's <br />1\'1:i I Zo2'� <br />Co -Applicant Signature <br />Printed Name <br />Title <br />Date <br />I understand that the application fee is non-refundable. All costs associated with the processing of this application are the <br />responsibility of the applicant whether this application is approved or denied. Any excess of escrow account deposits over <br />expenditures will be refunded at the time of account closure. I also understand that as the applicant, it is my responsibility to obtain <br />all other permits or licenses required by any applicable regulatory agencies for this Land Use Application. With notice from the City, I <br />understand the City may need to access the property for purposes related to the application. <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />)4. <br />t\vA\\saWk <br />\,\ \IM 'i <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />I hereby certify that I am the fee title owner/contract for deed vendee of record for the above -mentioned property. Failure to prove <br />ownership may void any agreements entered into the City and I will be held liable for any and all costs incurred by the City. <br />