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�� �. C���" o� ����T� <br /> post O�ce Box 6b•Crystal Bay,Minnesota 5a323•Municipal Offices <br /> il i ' <br /> � On the North Shore of Lake�Ylinnetanka - <br /> . - • • <br /> DATA PRSOAC� ��SORY <br /> -rn accordance with M.S. 13.04 , <br /> Subd. 2, "Rights af subjects of <br /> our request for a per�1t or <br /> of its departments may require <br /> data" , we Would like to inform you tnat Y <br /> of Orono or any � To�nation. <br /> 1; �ense from tne CitY r;vate or coniidential n- <br /> you to furnish ce�ain p <br /> vou are notifiea �nat: <br /> i, The inTormation you �u�nish wi11 <br /> be used to determine your <br /> cualiF'-ca�=On for the pe=�'� or license reqnest�d• <br /> " but r�Tusa1 may require that <br /> 2_ You may reruse to supp?y data, <br /> tne pe�-t or license. <br /> tne City deny local . s�a�e or <br /> ; �-' otner <br /> be snared w- �'� e,-mit or <br /> 3. The information may �- rocess tne p <br /> �- �-he extent necessary �o P <br /> f ederal agencies �-o �- <br /> license. . ; � ac��or_ <br /> or iice.^.se -e�yr�s Counc_� <br /> a. I� you= recuested pe�it uD1ic- <br /> to aporove, some in�or:nat-°n may become p <br /> You have �eYtain rights under M.S. 13.0 <br /> � to rev�ew �r'va�e <br /> J• <br /> Qzt� on yourse1r. <br /> `�, � appl_cation or <br /> 6. <br /> Your fu11 name is rec_u'-'-'ed �o proc�ss <br /> pe*-�it. <br /> — r , � � � nd er�� <br /> 12���r � �r� d �� r � -� Lzs� <br /> r irst <br /> Middle <br /> � `'J �J � �i 5 � ,,� . <br /> Address . c-f-�'S G <br /> MN- J <br /> � zip <br /> State <br /> City <br /> �� � � � <br /> Phone <br /> I understand my rights as stated above. <br />! �� . <br />} � � <br />:� . <br /> x . . <br /> Signature <br /> � pDMINISTRATION&FIN.�CE_;73-7358 <br /> � PUBLIC WORKS—473-7359 <br /> BUILDING&ZONiNG—473-7357 <br /> ASSESSING <br />