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H���� <br /> ��rt�� F� <br /> �`��� CITY of OI�011T0 <br /> �. � 6' .s�.i �ti� <br /> .ry, a S} �' ; ; <br /> ����t T �. -, <br /> •� � "� �E, ' � Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> .? <br /> 0 'S <br /> � � � �� r'�` On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of <br /> data" , we would like to inform you that your request for a permit or <br /> Iicense from the City of Oro e�or conf dent a Ie nf rmationmay require <br /> you to furnish certain privat <br /> You are notified that: <br /> l. The infor fo 1they�ermit or li ensebrequested, determine your <br /> qualification P <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or license. <br /> 3 . The information may be snared with oth=ocesscthe permit or <br /> federal agencies to the extent necessary to p <br /> I.icense. <br /> 4. If your reque ri od nP tlontmay be ome pub q�1res Counci i ac��or. <br /> to approve, some <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> pe?�mit. <br /> '� i,J �1�am �rS � <br /> �i�°.�� 19✓L t� Q <br /> First <br /> Middle Last <br /> �" �3�3 �o v� (1 �c � � �- <br /> Address <br /> V ( �� �,,� � j� yL� ���� �z- <br /> �`� State Zip <br /> City <br /> �� � a- -- � '� r ���� �� <br /> Phone <br /> Z u�d stan my rights s stated above. <br /> ;- , <br /> ;�� �2� G�G��`� -- <br /> ' gnature <br /> BUILDING&ZONING—473•7357 <br /> • ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />