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� <br /> � - �, ��'��" o� ����0 <br /> Post Office Box 6&•Crystal Bay,Minnesota Sa323•Municipal Qffices <br /> - aA � <br /> � On the North Shore of Lake Minn.etonka - <br /> s ' • • <br /> DATA PRSVAC� ��SORY <br /> a Subd. 2, "Rights oi su Dee mit or <br /> In accordance with M.S. 13.0 _ , <br /> our recuest for a r <br /> data" , we w�uld like to inf orm you th of its depa=t�nents may requi_e <br /> license from the City of Orono or any <br /> Y <br /> ou to zurnish certain private or cfln=-dential in=o�z�ion. <br /> v e notified that: <br /> ou a� ,- aur <br /> ou furnish will be used to dete_mine y <br /> �. The in=ormation y . L or liCense requested- <br /> ' i _cation f or tne pe="�='- <br /> cua_if ' ; re that <br /> refuse to supply data, but reTus�� m�Y requ_- <br /> 2. You may license. <br /> tne City der.y tne pernit or <br /> �-• oY 1oca1 , s�a�a or <br /> be snared with o �n--_ or <br /> 3 . The information maY <br /> to process tne permi� <br /> federal agencies to the ex�.ent necessary <br /> ?icense. . ; ac��or. <br /> Iicense =e�ir�s Counc_i <br /> t vou� requested pe�it or i ; <br /> �. I� • become PuD�-�• <br /> to aporove, some insormat�on m�Y <br /> � <br /> hts under <br /> M.S. 13_ Oa to rev�ew gr�va .-e <br /> � , You have certain rig <br /> data or. yoursel`. y . <br /> 6. Your full <br /> na�e is required to PrpC�55 th�= appl-ca�-on or <br /> pe-•-mit. <br /> - �1 <br /> , - ^ <br /> , � � � � <br /> _r,zs� <br /> �' � Middle <br /> =i�st �' <br /> — . ,-, �? � ����J�� <br /> , � � � `�� � ��/' v����' ' <br /> Address ;, � ,�_ � _l <br /> �;,,�. �fn r�)�/1-� <br /> �� , �i.,'`l�-,� z i n <br /> State <br /> City <br /> �.' � �' j <br /> phone <br /> I understand my rights �as stated above. <br />� I -� �n� �� � . <br /> , , <br /> f �_ . ' <br /> Signature <br /> • pDMIIyISTRAT10N&FINANCE-473-7358 <br /> • PUBLIC WORKS-473-7359 <br /> BUILD(YG&ZO`lING-473'�357 <br /> ASSE55ING <br />