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ilS,`11:y5 1;:?2 THE CIT'�' QF OROhJO h1�-�l"?-�?5" �J�J� <br /> N � <br /> II <br /> � <br /> �i�rY�f ��o�o <br /> Post O(t1ce Box 88•Cryai.al Bay,Minneeota bF,,323•Municipal Offic� <br /> 0 <br /> * • � * prt dhe Nosth Shore of�ake Minnetonka <br /> DATA PR�TACY ADV�SORY <br /> In accordance with M.S. 13.04, Su�d. 2, "Rights of subjects of <br /> de�.a"� we wouI.d like �G inform you thati your reques� for a permi� or <br /> 7LiC�nst� ��nm the City of �rono or any o£ its depaxtments may� require <br /> you to felrnish cexta�n private or confidenti.a3 infox'ma�ion. <br /> Xou are notified that: <br /> �. The �nfortn�tion you furnish w�.il be u$ed to determine your <br /> qualification for the perml.t or license reques�ed. <br /> 2. You may refuse �o supply data, but refusal. may requira thst <br /> �he City deny the �eXmit or license. <br /> 3. The �.r�formatiion m�y be sYzax'ed with othcr local , stat� or <br /> federal ag�ncies �o the ex�ent necessary to process tt�� pezznft or <br /> ?icense. <br /> 4. Tf youx' zequested permit or �icense requires Counci?. action <br /> to a�grove, some informat�on may become public. <br /> 5. You hdve Gt�rtain rights under M.S. 33.OA to revi�w pri�a�e <br /> data on Xourself. <br /> 6. Yc.uz' ful�, na3�tP is requize� ta process this ap�3ication or <br /> permit. <br /> ._,Ti,'i'�iN :��:.:U�� �i'��I:� <br /> First Middla Last <br /> 324�1-r�LAG �OuT�-� <br /> Address <br /> ;4�I�JiVEAYOLIa �:IcvT:1 j5�16 <br /> City State Ztp <br /> 720-��8F38 <br /> Phone � <br /> I understand my ri hts as stated above. <br /> ,� <br /> � <br /> � � <br /> ���r � �, <br /> :� <br /> s�gna re / <br /> BUILDING&ZONING-473-7357 • ADMIS�iISTRATIQn&FIMAPICL• -473•7358 � FUDLIC WORKS -473-1:�59 <br /> ASSESSIN G <br />