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r <br /> i <br /> CITY of ORONO <br /> Post Otfltt DX es-cryMj M74 WawWaa aS1ti•Mgddfil 01ft • <br /> e On the Notfh Shoe of Lake Minnstoftka <br /> TA BRZVACY AD�VI8OItY <br /> ects Of <br /> In accordanos Mith M•S• m3'ou�thatdyour request Corhts of sa permit nr <br /> dsta". we would like to inform Y <br /> license from the City of Orono <br /> or <br /> ccntdeAtial department* <br /> nformation."sy requi�ra <br /> you to furnish certain privet <br /> you are notified that: <br /> 1' The information rAypermft or license requested- <br /> . <br /> equesto• determine your <br /> qualificati <br /> Z. You may refuse to supply data. but refusal may require that <br /> the City deny the permit or licena*. <br /> 3. The inf ormatebe shared hother cthe <br /> state or <br /> federal agencies to the extent necessary to p oca spermit or <br /> license. <br /> 4• I! your requested permit or license requires Council action <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 /> me is required to process this application or <br /> 6. your full nai <br /> permit. <br /> I <br /> id le Last <br /> First m!� <br /> Ad <br /> CP <br /> s Starts <br /> sip <br /> �s z� <br /> Phone <br /> I understand my rights a ed above. <br /> gnaCure <br /> IUIL�MC�ZONING-•'►7-77ST • AOM1N13TRATION R�NANCE-173-'►1ii ►UtL1C WORKS-177�7If! <br /> • ' <br /> ,�easrxc <br />