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04i08i92 16:08 THE CITY OF ORONO 612-4?3-7357 008 <br /> CITY af [lR�N� <br /> Post Oft�ce E�ox 68•Cryatal Bay�Minneeota�5323•Municipal O�'icea <br /> � <br /> � � � � Qn the North Shore of Luke Mi�neto».kac <br /> DA�'A. PRIVACY ADVISORY <br /> IA aCCPrdBt�ce with M.S. 13.04, Subd. 2, "Rights of stzb�ect� o£ <br /> dat�", w� woul.d like �o inform you that your request for a p�rm�.t or <br /> IiCeASe �rom the City Of Orona or any af its departrnenta m�y requiXe <br /> you to £urn�.sh oerta�.n p�ivate or confa.den�ial information. <br /> You are not�f�.ed thats <br /> 1. The �.nfcrmatxan you �u�nish w�I1 b� used to determine your <br /> quali.fication �or the p�rmit ar l.icense rec�uested� <br /> 2. You ma,y refuse to supply data, but refusal may require �hat <br /> the Cfty deny the perm.iti or ��.cense. <br /> 3. The in�ormation may be shared with o�her �oca3., sta�e or <br /> federaZ agencies �o �h�: extent necessary to proc�ss �he p�x-mit �r <br /> lic�ns�. <br /> 4. If your requested permit or 3icerise r�quires Gounci�. �ation <br /> to approv�, s�m� infQrmation may became public. <br /> 5. You have Cert�iri �iqh�s under M.S. 13.04 to �ev�.ew privs4G <br /> data on yoursel.f. <br /> 6. Xpur �u�.3. name is required to process this ap�Zi�at�.on ox <br /> p�rm�.t. <br /> � <br /> First Middle Last <br /> l 0l(a_(� �'����n � �V� <br /> Add�ess <br /> .f �t(� ,T��.� ��14'E'aA `�'.�`-t�.� <br /> C�.ty Stiat� Zip <br /> �_ _.__... <br /> Phone <br /> I understand my righ�s as st�ted abov�. <br /> � �, ' �. ' ' %� <br /> S�gnature . <br /> F�U[LD11VG Bz ZONtIVG—47J-7357 • Al)MlN1STRATJON dc 1�INANCB—473-7358 • PLIBLIC N'O�KS—473-735? <br /> ASSGSS�NG , <br /> . . <br /> .� ' , <br />