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10/18/94 16:26 THE CITY OF ORONO 612-473-7357 003 <br /> CITY of ORONO <br /> CITY Post office Boz 88•crystal a•r•Minn"Ots 9.5328•ManiciVsl OMee• <br /> OF <br /> • R • • <br /> On the North Shore of Lake Minnetonka <br /> 6k —ADATA PRIVACY ADVISORY <br /> in accordance with M.S. 13.04• Sud.ou= request folrhts Of sa per it or <br /> ects Of <br /> data", we would like to inform you thatY require <br /> license f Fom the g ivat�or confi dential of its information. 9 <br /> you to furnish certain <br /> You are notified that: <br /> 1, The information you furnish will be uUeS Qa•detez'mine your <br /> te <br /> qualification for the permit or license reg <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or license: <br /> or <br /> 3. The information may be shared with other oalt the pe mit or <br /> federal agencies to the extent necessary to process <br /> license. rmit <br /> tion mor license ay be come public,res Council action <br /> 4. If your requestsd p <br /> to approve, some informa <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 <br /> Mid le Last <br /> Address <br /> State Zip <br /> City <br /> Phone <br /> I understand my rights as stated above. <br /> S I gnature <br /> BUILDING A ZONING-473.1357 • ADMINISTRATION A FINANCE-473-7338 • PUBLIC WORKS-473-7339 <br /> ASSESSING <br />