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, � . .� <br /> ' �. - ����' o� (��R►�I�"O <br /> N■ <br /> Post Office Box 66•Crystal Bay, Minnesota 5�323•Muaicapal Qffices <br /> � - <br /> •- On the North Shore of Lake Minrzetonka <br /> • - • • <br /> DATA PRNACY ��SORY <br /> Subd. 2, "Rights of subjects of <br /> In accordance with M.S• 13�ou�that your request for a perm u re <br /> d a t a" , we Would like to inform y of its depart:nents may req <br /> license from the City or Orono o r a n y <br /> you to furnish certain private or confidential inzormation. <br /> you are notified that: <br /> 1, The insormation you fu�nor ZiCensebrequested, aetermine your <br /> e�-:n-�. <br /> qualification for t��' P that <br /> 2. You may refuse to supply data, but rerusal may require <br /> ty.e City deny the permit or license. <br /> be snared with other local , s�a�e or <br /> 3 . The information may rocess the pe�1� °i <br /> f ederal. agencies to the extent necessary to p <br /> �icense. • <br /> ermit or Iicense requ�res Councii ac��or. <br /> d. �f your recuested p ub1iC. <br /> to aporove, some in=ormation may become p <br /> J • <br /> You have certain rights under M.S. 13. Oa to rev=ew pr=Vc�e <br /> data on yourself. <br /> o �-zis apolicat�or. or <br /> 6 . Your full name is required to proc_ss �� <br /> pe�it. <br /> ,��?h � ��` �` �� � � �` �� Last <br /> First <br /> iddle <br /> U � � G �i�' ��� � i/r<r. ,�, <br /> AQClre55 <br /> / �1� u I� ;� VV) il, . S � �E / ZiD <br /> State - <br /> city <br /> y�,1 �� � `� <br /> Phane <br /> I understand my rights as stated above. <br /> 1 � '� <br /> ,---�/``/ L � . - �'-��i �`. (- - . . <br /> Signa re <br /> 6UILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-�73-7358 <br /> • PUBLIC WORKS -4�3-�359 <br /> ASSESSING <br />