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; ■• . •. • I* -- ' i' r..Jm- <br />1 must obtain <br />3 Govt Center <br />each of the <br />Irese labels <br />rate list of <br />plication is <br />tsessments) • <br />it. <br />is complete. <br />$150.00 <br />230.00 <br />300.00 ^ <br />20.00/Lot <br />150.00* <br />required or <br />if Attorney* <br />.ication and <br />nee. <br />/O <br />t before the <br />held on the <br />L scheduled <br />pplicant is <br />to have an <br />ng & Zoning <br />................ ^ <br />4 mmmmms <br />{ <br />CITY <br />OF <br />QRONO <br />CITYrf ORONO <br />Poit Office Box 66*Cryetal Bay. Minneeota 56323•Municipal Offioea <br />On the North Shore of Lake Minnetonka <br />DATA PRIVACY ADVISORY <br />1. <br />2. <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 />• ♦ <br />You are notified that; <br />The information you furnish will be used co <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 />If your requested permit or license reqaires 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 />Your full name, and date of birth are required to process <br />this application or permit. <br />3. <br />5. <br />6. <br />k S O- <br />First _ <br /># <br />Middle <br />a /c^TM _ <br />Last <br />/p/LJ <br />Address <br />Date of brrtK <d6eB~not apply to buildihg/general permits) <br />Phone <br />I understand rigMis as ^ated above. <br />•UlLfMNG a ZONINO <br />assessing <br />Signature <br />475TJST <br />• ♦ <br />ACMIINISTRA7ION 4 FINANCE - 473-T3IS RffljC WORKS - 473-7359 <br />DESCRIPTIC <br />a Jk <br />TT I <br />Those P4 <br />plat the <br />of the 5 <br />Coir <br />No. <br />0 d <br />A, <br />des <br />521 <br />of <br />deg <br />dis <br />Tra <br />158 <br />The <br />October !