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resulting from stricting compliance with Zoningthin 150* (you must obtain Finance A-603 Govt Centeraddressed to each of the ress (use address labels <br />Iculations as required, <br />levations) if any changes <br />attach a separate list of <br />application, <br />staff. <br />Is application. Please <br />t complete if the above <br />pplication is complete. <br />Date <br />Information required or <br />to pay all fees and/or <br />ation, and certifies that <br />to the best of his/her <br />L Date^0^37 [9&9 <br />application and further <br />City staff, consultants, <br />>r purposes of investiga- <br />Date ^7 <br />ffices 25 days before the <br />Meetings are held on the <br />resent at all scheduled <br />oil. If an applicant is <br />arrangements to have an <br />te the Building & Zoning <br />amI■ ■ K ■. / <br />1 <br />- ,f ri4 <br />V. <br />, ■ ! <br />P#iii <br />ftDATA PRIVACY ADVISORYIn accordance with M.S. 15.165, "Rights of subjects of data", we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to furnish cn.vti»in private or confidential inform' ation.You are notified that: <br />The information you furnish will be used to determine <br />your qualification for the permit or license requested. <br />You may refuse to supply data, but refusal may require <br />that the City deny the permit or license. <br />The information may be shared with other local, state <br />or federal agencies to the extent necessary to process <br />the permit or license. <br /># <br />If your requested permit or license reqires council <br />actirn to approve, some information may become public. <br />S.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 />^duj A^DS <br />itSO. <br />'’rf LOWS. Mi/- <br />bate of birth (does not apply to buildihg/general permits) <br />{H) 9P1- <br />Phone <br />I understand my rights as stated above.• • « a • • • **• * * * • <br />^ —’g-*-•« u • *r— <br />Signature - - - <br />_ _--.t.-*" <br />. . • - . .- . ... 1 P <br />. MM . - IM ■ • . A .MM. <br />. -MM I WMt ■ ■■ ii—mm mm <br />. mmm.^fm.mmrn t **■ ' <br />T~. _ - ..^-.-1 P^" •'■'m-n ~-n3Sn wrw •— •- • ~ vt-pt <br />. .M.M m mm. 1 ■ Ji J.-*i ■ .. » p mSt— <br />V <br />^rVV <br />i.f <br />SJ*'4 I <br />.4-i' <br />W-'---S';-•