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� 10i18i94 16:26 THE CITY OF ORONO 612-473-7357 003 <br /> � _. � _.. <br /> ' � w <br /> �� <br /> Ci���O� ��►0�� <br /> Pes�Utiice 8ox BB•CrYatat Bay�Mineesots g.53Z8+Manici0�Offices <br /> s � <br /> • � • � pn the North 9hore of Lake Minnetonka <br /> DATg PRIYACY ADVISoxY <br /> In nacordanoe with M•5. 13•ourthatayoui request goXsa per it or <br /> dat�"► we would l�.ke to inform y <br /> I,icenBe f Fom the City ° riv�te or conf�.dent�a� in��ationmaY requ �e <br /> you to £urnish certain P <br /> You are noti-Eied tihatz <br /> 1. The ingormationeY���i�nor li ensebrequested. de�ermine your <br /> qua].i�ication for th p <br /> Z. Yvu may refuse to supp3.Y dara. but ref�sal may require that <br /> the City deny the pern+it cr licease• <br /> 3. The intorma�ion may be sh�red with ot�eorCe ��th� pe�it or <br /> federaZ agencies tv tbe exten� nacessary to p <br /> 1.icense• <br /> 4. If your requestsc7 at on may be ome puhl��eS Counai3. aetion <br /> to approv�, some in�o�.^m <br /> g. ycu bave certain rights under M.S. 13.04 to rev3.ew private <br /> data on you=self. <br /> g, your full name is zequired to pxo���s �h�s app�ication or <br /> p �. <br /> �c--�� <br /> 1�--� <br /> Firs� <br /> Mid e Last <br /> � J <br /> Address � <br /> City <br /> e State zip <br /> � <br /> Phone <br /> i urid rs nd my <br /> ri s as �tated ab - <br /> qn ure � <br /> BUIL�iNG ac 20N1NC-��3•'/3S7 • ADMW197RA770N�F�AN�-477-7358 • PUBLIC WORKS-473-7339 <br /> ASSFS5ING <br />