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, , <br /> : � <br /> �.:�'T'�.' �or�' ta�.��.'1Tt� <br /> Poat OFEice Box 68•C�yetal Bay,Minneeota bG323•Munidpal 0!licae <br /> • <br /> � - 4 i On the North Shor�of Lake 11?innetonka <br /> DATA PRNA.CY ADYI84RY <br /> Irt �..^.cerdgr�Ce W�th M.S. 13.Q4� Sui�d. 2r "Rfgh�s a� sub�ects af <br /> da�a", we wou�.d like to �.nform you �ha� your request t'or a permit or <br /> license from the City af drono or �ny of its depart:nents may require <br /> you to furni�h �ertain priva�e or con�'idential information. <br /> You ar@ rtotif ie�I �hat: <br /> 1. The infozma�ion you furzish wiil bE used tc det�rm�ne your <br /> qua�.�.f�.ca�ion for �he permit or licenge reques�ed. <br /> 2. You may refuse to supply d2�ta, but re.�usal may require that <br /> the City deny the permit or licen8e. <br /> 3. The information may be s�ared with other local, s�a�e or � <br /> £ederal agena3es to �he ext�n� necess�ry to pracess, tbe permit or <br /> �icense. <br /> �. rf youx requested p�rmit or Yicense rec�uires Council a�tian <br /> �a approve, some infd�'ma�ion m�y becdrne pUb1�.C. , <br /> 5. You have certain riqhts un�let- M.S. 13.�4 �o r.ev3.ew privat� <br /> data on youxself. <br /> 6. Your EuI.1 name �s requi��e,� �o proces� this applfCa�ion ar <br /> permit. <br /> � k�.��,p .,��Sh'�� /1/olz,JGtv�s� <br /> Fi�t �ddle Last � - <br /> �O 4 5— �/ u G�-r�s' �'T - -- <br /> Address <br /> �C�,I�'v/�� f2�/�- - SJ7/� <br /> r <br /> City State Zip <br /> ��G ' ��G G �_ . <br /> Phane � <br /> I unders�a»d my xights as st�tt�d abevR. <br /> � � . <br /> s gnatux� , <br /> oU1LPiNC:�ZONING—473-7357 • A,DMINISTRATIQI4�F1IVANCE—473•7�58 , ` s PU�ttG WOAtlC$—473•9339 <br /> A55�5SIN� <br /> c►7n LS�1—��t�—�T 9 i�t K1;�i� .-fi� ,ll 1� =���._ t��-�:T T r�..�a,��r'0 <br />