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ved; —ved:Project#: <br />pletely and signed <br />ing: <br />iting and proposed <br />trading and drainage <br />lEtr WILL BB STARTED <br /><rcy^ I <br />iT Acras *• i.7fe <br />/rr A P7 iti \J Lma if 4 <br />(work f <br />HB: (home) <br />_ _ ZIP; <br />B: <br />ZIP:2%£ <br />Bs - ?r.r»r' <br />ZIP; <br />Move <br />Alteration <br />X. g/SV'S flA 46»>- <br />ut^ll A 9^^ ktJAck <br />t <br />:hat the informatioi <br />conformance with th <br />ilding Code; that <br />mit; an< <br />BATH; y - /-3 - yg <br />crm) <br />IK <br />mi <br />■ .'. :x. <br />.VVI": , <br />iiil <br />Un <br />. . :. : 'i1 <br />J ft /’r CITY of ORONO <br />Post Office Box 66*CrystaI Bay, Minncaota 56323•Municipal Offices <br />On the North Shore of Lake Minnetonka <br />0MTR.Jgl8Ig»gt-«agSQRT <br />;i-l <br />WM ^ : <br />In accordance with K.S. 15.165» "Rights of subjects of data"# we <br />would like to inform you that your request for a permit or license <br />from the City of Orono or any of its departments may require you to <br />furnish certain private or confidential informationo <br />You are notified that: <br />■ ;--:r <br />1. The information you furnish will be used to determine your <br />qualification for the permit or license requested. <br />2. You may refuse to supply data# but refusal may require that <br />the City deny the permit or license. <br />•i.j <br />3. The information may be shared with other local# state or <br />federal agencies to the extent necessary to process the permit or <br />license. <br />4. If your requested permit or license requires Council action <br />to approve# some information may become public. .... <br />5. You have certain rights under M.S. 15.165 to review private <br />data on yourself. <br />6. Your full name# and date of birth are required to process <br />this application or permit. <br />■ L_________ifcats.4f*jyBriibin iitm m' in <br />Middle <br />i '=R o^er. . - T--. .. A-____________ <br />Last <br />• ^ <br />d^^s- • -tffiTuntniTi .ii 4UA U MaiiB <br />:E • ti <br />... <br />i* ■' <br />Addrei <br />: ............. <br />City ^ . : <br />. RT. jrii lirif <br />1 •• <br />r laiii IState <br />1 __Zip <br />Xim <br />• «»• <br />Phone <br />I understand my rights as stated above* <br />‘ ^ <br />4X ^ j k. <br />w>»•s. <br />i • *• <br />• <br />♦ • ^... <br />22Hr>,Signature <br />A/Ivs... <br />BUILDING A ZONING - 473*7357 <br />ASSESSING <br />PM <br />nmm-^ ■ ■mmm <br />f^v-. • <br />mw' <br />L'-v- <br />i- <br />pyp ’-- • ■-.iV <br />-mMm <br />■ <br />•V ; <br />- :->x ^ ■ ■ •• 0 <br />iiiWi <br />l^Vv- <br />ai|g <br />mila®' <br />wm <br />*t» ;•