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CITYof ORONO <br /> Past 0Vkt 90 noCrynal My.MieaeM 0v2VMU**PW 0"hM <br /> e on the North 9hvrc of Lske Minnetonka <br /> ��. pRIV�CY 11D�V=SottY <br /> in accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we Mould like to inform you that your request for a permit or <br /> license from the <br /> p><ivate or conof Orono or fident al Of info:cmation. require <br /> YOU to furnish <br /> You are notified that: <br /> lutilifieation for the permit or lienseon you furnish will brequested, <br /> e used to determine your <br /> 4 <br /> 2. You may refuse tossupply <br /> ddata,, <br /> but refusal may require that <br /> the City deny the Permit <br /> 3. The information may be shared with other local, state or <br /> federal agencies to the extent neesseairy to process the permit or <br /> license. <br /> 4. Ifp.= omsy irlforinet�.onit may become pubermor license s c res cCouncil action <br /> to apps <br /> 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 process this application or <br /> permit. <br /> First Middle <br /> as <br /> Address <br /> city State Zip <br /> Phone <br /> Z understand my rights as stated above. <br /> Signature <br /> SUIL PING•ZONING-4731351 • ADMP"STRAIM a FWAKt-471-7138 • FUNLIC WORM-47;-73!9 <br /> A"XMING <br />