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� 10i18i94 16:26 THE CITY OF OP.ONO 612-473-7357 903 <br /> . ---.. <br /> ���c� �� o�o�o <br /> Post Ut1tc�Box 66•CrY��t Bay,Minnssota 55323�Mnni����'� <br /> � Qre the North Shore aj�ake Minnetonka <br /> � - • • <br /> DATA PRIVACY A��SoRY <br /> "Rights of subjects o� <br /> zn accordance with M.S. 13.04, Subd.o�= re uest for a permit vr <br /> we wou].8 ii.ke t�o£i�rorio or an h of its departments may require <br /> data"► y <br /> Iicense f�om the City r�vate or confi-dential information. <br /> you to £urnish cextaia P <br /> You are notified t:�ats <br /> 1, The infozmation you furnish wiZl be uuested,detErmine Your <br /> qnali£ication for the permit or license re4 <br /> refuse to supplY data, but refusal may require that <br /> Z. You maY the perrnit or license. <br /> the City deny <br /> be shared with other local ► state °T <br /> 3. The intorma�ion may tio rocesa the permit ar <br /> federaz agencies to the extent necessary P <br /> license. <br /> �. If youz requestsd permit or license requires Councii action <br /> to aPPrpVer some information ntay <br /> become public. <br /> 5. You h$ve certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> g. your full name is zequired to pxocsss this application or <br /> percnit. _ <br /> _ � <br /> � �' ,� ( L� <br /> First Middle <br /> ,� � / <br /> ` <br /> Address � <br /> � <br /> � i <br /> State Zip <br /> Cit <br /> ��.� �.��s . <br /> Phone <br /> Z understand my rights as stated above. <br /> _ ' 1 <br /> � � �� <br /> r <br /> Szgria ure <br /> BUILDING&ZOP�tNG—d73•7357 • ADMINISTRA'TYON�FINANCE—47�-7358 <br /> • PU8L1C N'�R�—473-7359 <br /> ASSESSiNG <br />