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, , 10/19i93 15:56 THE CITY OF ORONO 612-473-735? 002 <br /> ,o:;: <br /> � c��c�o� a�oNa <br /> Past Ol�ia Bo�c 66•Cry�W syr�Minnasots 663sa��t�nie:p.1 O[h�. <br /> • ' • • O�t ths North Bhore of L��`�i�eruto�ka <br /> DATl� pRIYACY AD`TISORY <br /> In eccozdanca v�ith M.S. 13.04, Subd- 2. "Riqht� of sub ject� of <br /> data", ws Would like to inform you that your requeat for a permit or <br /> licenae f rom the City of Ozono o= any of its degartmrn�s may require <br /> you to gurnish certair► private or cortffdantial informabion. <br /> You are notf.fied that: <br /> 1. Th� information you fusniah wi13 be used to deter�ine your <br /> qualificstion for the pormit or license requested. <br /> 2. You msy refuse to supp�y data. but refusal may requise that <br /> the �ity deny the pezn►it or Zicense. <br /> 3. The i�formation may be s�hared with other locsl , ctate or <br /> federa� agencies to tho extent necesaary to prvcas� the permit or <br /> licenae. <br /> 4. If your requested permit o= 1�eease requires Councia. action <br /> to sppzove, some intozmation may become public. <br /> 5. You have certain riqht; undex M.s. 13.04 to rsview priva�e <br /> data on yourself. <br /> d. YouZ �ulY name is tequired to process thi� appZication ar <br /> permit. <br /> � � �o' � � <br /> Firet iddle Last <br /> � <br /> Addross <br /> / � S^ ^ <br /> City Stat• zip . <br /> �� � —���'� <br /> phone <br /> I u stand my riqhts as stated above. <br /> ., _�� <br /> � - -----� ' <br /> qnature • <br /> BUILDING d ZONING-473•7357 • wUi►11NIS7RATION�PINAIYCE-,73-�35B • PUBIK WORKS-473-7359 <br /> ASSESSINC ' � <br />