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�.. . 1 <br /> ` ITY of 4RON0 <br /> C <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � _ � � On the North Shore of Lake Minnetonka <br /> DATA PRNACX ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would Iike to inform you that your request for a permit or <br /> license f rom the City of O at�o=r �onf dent al e nf rmationmay require <br /> y o u t o f u r n i s h c e r t a i n p r <br /> You are notified that: <br /> 1. The inf orma��i�heY°ermit or Iicensebrequested, determine your <br /> qualification f P <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may be shared with other Iocal, s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense requires Councii ac�iar_ <br /> to approve, some information may become public. <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 prvc�ss this application or <br /> permit. <br /> S l �1 . �� <br /> First <br /> Middl.e Last <br /> � �ho� S ���-(.._1� .�(�.,��c <br /> Address � <br /> �� � �3� � <br /> Ca�� ,�,��� . <br /> City State Zip <br /> �4'1 --� �_ <br /> Phone <br /> I und stand my rights as tat ab ve. <br /> Signa . � <br /> BUILD[NG&ZONING—473-7357 <br /> • ADMIIVISTRATION&FINANCE—373-7358 • PUBLIC WORKS—473-7359 <br /> ASSESS[NG <br />