Agenda - Council - 12/12/2023 - Laserfiche WebLink

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Property Owner Information (If different than Applicant) � a r; Name: r Street Address: City,State,ZIP: Home Phone: s s �`��-�-� Work Phone: ' Email: Fax Number: Please provide a detailed description of your request and attached a copy of a scaled site plan 5 � o LAM W�A 'A �ookNl\-\%xt ra�d- chtl all(k �0%t . Uc15 ti 15 1150 40A avc W"S. M(\ L1 aK5 W'Ae' \S a (All MM-Q 13 ��5 Lt� a old 514.0 � o 'pan � 5 L2 ears o� acle a 6�me �n�a 111, S ��1 ��l 5 0l � �5 a 1 0 � ►� � ti� �5 !MIA d e are g e e 5 t �1 e \i\ hevs► � rr►ore 5 .� c a netall t 1e a la ko n kJ y oo o e erc � A "Land Use Sign"will be placed on the Subject Property to allow Ramsey Residents the opportunity to obtain information about your request. Applicant Signature r Co-Applicant Signature Printed Name �v1 1• �O�h�1 Printed Name Title � Title Date �j�''�,U2� Date I understand that the application fee is non-refundable. All costs associated with the processing of this application are the responsibility of the applicant whether this application is approved or denied. Any excess of escrow account deposits over expenditures will be refunded at the time of account closure. I also understand that as the applicant,it is my responsibility to obtain all other permits or licenses required by any applicable regulatory agencies for this Land Use Application.With notice from the City, I understand the City may need to access the property for purposes related to the application. P roperty Owner Property Owner Signature Signature Printed Name • �f��r1vk Printed Name v v � Title �S , Title -Date ��1'J�i1�Q'l� Date I hereby certify that I am the fee title owner/contract for deed vendee of record for the above-mentioned property. Failure to prove ownership may void any agreements entered into the City and 1 will be held liable for any and all costs incurred by the City.