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IMI ^■mmLd[IViirkAU <br />L?^ <br />ou can obtain <br />13 Government <br />of the names <br />) if land <br />;s). <br />ite list of <br />1. Please <br />nnation has <br />;omplete. <br />quired or <br />es and/or <br />ifies that <br />f his/her <br />id further <br />isultants, <br />poses of <br />>efore the <br />Id on the <br />scheduled <br />licant is <br />3 have an <br />& Zoning <br />-r: -Jt 1.Iy.-%fci- <br />:.-i • • •• <br />' ;;:i <br />mBmm <br />rJT^r/: <br />mf'-mrnm: <br />■V v;^/. :••■.=.;..: •.■■ : .;• ,:•••-; . <br />jiViv v-:r--:.: ; - <br />..V . < Sf, ■; ■ : . - W <br />ptiiw <br />r <. <br />i <br />■■m: ■■ y:^? :K^.v,:%=-h ..r ., ^,m., ': i: ■ V .A ■ •-.y :i P , ^v- A"-;;'R^v\- '• ^ '-V"^ V'.yy-i^y- <br />■ jmMm' ■ <br />; -V- ■- : . , <br />ryyy - y <br />Bh(a» •*..• 7^^^. <br />i1 ■...;■■ti:. <br />•• vi^ <br />ym <br />t'A ' yy:;'' V-^-vsvjhcjr»nTiJ \yy V <br />DATA PRIVACY ADVISOi^Y <br />In accordance with M.S. 15.165, "Rights of subjects of data", <br />we would like to inform you that your request for a permit or <br />license from the City of Orono or any of its departments may <br />require you to furnish certain private or confidential inform­ <br />ation. <br />You are notified that: <br />1.The information you furnish will be used to determine <br />your qualification for the permit or license requested. <br />2.You may refuse to supply data, but refusal may require <br />that the City deny the permit or license. <br />3. <br />4. <br />5. <br />The information may be shared with other local, state <br />or federal agencies to the e.^tent necessary to process <br />the permit or license. <br />If your requested permit or license reqires council <br />action to approve, some information may become public. <br />You have certian rights under M.S. 15.*165 to review <br />private data on yourself. <br />6.Your full name, and date of birth are required to process <br />this application or permit. <br />Q[lC^O OMP. Sc^Vtoou C^t^UlvcT ^ZT[^ <br />First Middle Last <br />C?UO C.<LV^rAi^ ftAV OflAQ <br />Address <br />LOhl/1. L.A4i>g ■ AAA/. <br />i • <br />Date of birth (does not apply to buildihg/general permits) <br />Phone <br />- I understand my rights as stated above. --, <br />•~X ----riT <br />Sxgnature <br />. ■■:-yyy^mr;:nliS ;;•■■ <br />pmifcil • ^ <br />yy^a^y' ^ ■:■■■■■ ■ <br />y’pmyp^y ■/ <br />••; .••;•:,>■ ;* r;.: .;•;;. <br />V'-:: J: <br />‘>. V- <br />^rV> b <mb'I <br /><.v <br />-J ■; ^.’S <br />■yy^t- <br />b»- <br />^yWK:. ^:.c ■■?*r :■■:■;■•.«^P:mp:yy <br />■'■ ■■ ■ * '■ <br />, -i <br />> ;•'-. ^ •. ■ •...• • . :i;->■■-" ■ <br />yyp^my. - -m y-y'..Mmm- <br />-' -rybyp^- <br />Pi <br />WpyWm > <br />yymmb‘i <br />' yywyyy <br />mmi:.y <br />yympy <br />s^ar <br />:...,. t- <br />ii> \ ■■'I <br />JfKsSi <br />M'l <br />fen'-'-■■■y-r,:.',- ^ <br />yyy^ <br />M^'yyyy <br />■■•: ri»; ■:;.: <br />I .<■Si3»2?^-A w.■«>.•••.-r* <br />m <br />^■yy-y-r'ywyyyyi <br />yyyyyyyy^y y:- ■ ■■.m <br />■i- ' ■ * <br />myy.y . , ' -■'-■pyyyi-y P--.y <br />yppyyypy' yyyyp. <br />yp-Pc <br />‘l. Vj <br />•: ‘^X- <br />'y "yypppp^ <br />--.Vi-- a • f-- <br />?my yy- " <br />'^pyy <br />y-ypy <br />• -'W' <br />ym <br />ypy ■ ^ <br />'mmyyy <br />./■■ '■>•.•>':AS <br />v •.: : ’/■' ' • •■. ■ ..-■■PpypP\Py\yp: \ 'y <br />;*’:KwrWfevMii <br />ypyr:-:'^^yP:\iy'y^ <br />yyyyy.y^P-ymy:-i <br />P5-: <br />rrymyif' <br />% <br />b: -r-y'p.mii <br />yyppy%yy:i\ <br />■»<" ■•'■' ''V- <br />_ : y:-.‘-V' \,-.: <br />y'.' •■ *'.;■ - = •