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V •• A'':^:V-'. «•jj*. .V V■ V..'V f9 fro* fttfelct13»an«>4«;e with Zoning <br />lu Must obtnin <br />)3 Oovt Conter <br />o onch of the <br />IdresB labels <br />e required* <br />Lf any changes <br />>arate list of <br />tion. Please <br />if the above <br />is conplete* <br />required or <br />fees and/or <br />lertifies that <br />t of his/her <br />>-28-1987 <br />on and further <br />f consultants* <br />i of investiga-. <br />M-1<M7 <br />lya before the <br />e held on the <br />til scheduled <br />1 applicant is <br />ts to haVO an <br />ding fc Zoning <br />V--:. ^ <br />•-r ' ' <br />-v:; •• <br />.'■V vr <br />. <br />W0»\ <br />stm <br />':e. . <br />m <br />mm <br />m <br />r,5'V <br />r\" .1' <br />■■U pr-^m. <br />mx <br />‘4T <br />h: A <br />Xm\m-y\. <br />A •«.). <br />M m -.5- <br />m: <br />Pi, •;■••'i-'=: <br />-vf <br />, ■• •■■■ ■ <br />vV • <br />\% <br />vmM- <br />-"A. ■ <br />;-mmi:mmrnmf^mmmrn <br />?VA>" <br />» e #1240DATA PRIVACY ^BvISerf <br />license from the City of Orono or any of its depertsients nav <br />r^uire you to furnish certain private or confidential infore <br />You are f»tified that: <br />1. <br />3. <br />The information you furnish will be uied to determine <br />your qualification for the permit or license requested. <br />You may refute 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 />4. <br />s. <br />i <br />If your requested permit or license reqires council <br />action to approve, boom information m^y becoem public. <br />You have certian rights under H.S. 15.’l€5 to review <br />private data on yourself. <br />Your full name, and date of birth are required to process <br />this application or permit. <br />tide <br />Plrst <br />Leroy Plalsted <br />Middle <br />15267 Hlghlend Trail <br />Address <br />Winnetonke, Kinn. 55545 <br />Last <br />birth (does not apply to buildihg/general permitsi <br />I unde^tand my rights as stated above. <br />X . <br />"gndtu <br />s4. *