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»^- <br />% <br />Bust obtain <br />Govt Canter <br />kach of the <br />ass labels <br />ite list of <br />Licatibn is <br />essmants ) • <br />s complete. <br />150.00 <br />230.00 <br />300.00 4- <br />0.00/Lot <br />150.00* <br />squired or <br />Attorneyt <br />Lcation and <br />ce. <br />-/o <br />-.fJ- <br />before the <br />mid on the <br />scheduled <br />>plicant is <br />to have an <br />q f Zoninf <br />••TV"^ .^ •u» •• <br />M <br />■■ •• ..- >■ . u ‘- <br />! ■ •» <br />m <br />I <br />.n>-<. it. <br />U-" <br />•fe. <br />■■M <br />1 ' ' <br />i i V <br />I CITY I1 I■ QRONC^j <br />CITY of ORONO <br />pMt Ofltca Box 66*Cry«t«l Bay, BlianMOte 56323•Munidpal Offiow <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 perait or <br />license from the City of Orono or any of its departments may require yort“furnish certain private or confidential inform- <br />ation. <br />You are notified that: <br />The information.you furnish wUl be used to detem <br />your qualification for the permit or license requ. <br />~;s: “.5 u r /.su.ra-p:“s. <br />the permit or license. <br />If vour requested permit or license requires 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 />vour full name, and date of birth are required to process <br />this application or permit. <br />4. <br />5. <br />6. <br />vj" cz/t<=-^A/ <br />First _ <br />Address <br />Middle <br />•=> <br />ofte of birth (aS55~not apply to buildihg/general permits) <br />Phone <br />I understand m^ rigM;s as Mated above. <br />ignature <br />■UtLOING a ZONING - 471*7357 <br />ASSESSINvG <br />AOMINfSTRATION 4 FINANCE - AtMlJI m FUBLIC WORKS -47MSI4