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� <br /> 02i1ei95 16:23 THE CITY OF ORONO 612-473-7357 �01 <br /> � �ITX of �R�NQ <br /> Yost Office�ox 88•Crystal I3ay�Minaeeota 6b32:3�Municig�t]Of�C� <br /> / <br /> � � � � On thz North Shore of Ldhe Minn�tonka <br /> pATA PRIVACY ADV�SO�tY <br /> In aacordanae with M.�. 13.04, Subd. 2, "Ri.g'hts of sub�ec�s a� <br /> data",; we wou�d 3.ike ta infarm you �ha� your 7�equest ���' 8 pe�m�'uize <br /> you to fu�cn�sh c�taxn px�ate or conf dentia� 3 f rmationmay �eq <br /> You aZe notified t.hat- <br /> l. The �n�orma�ion you �urnish wil.�. be used �o determi.ne your <br /> qualifzcatiion for th� perI►zi� or license requeSL�a. <br /> z. You may refuse to supFZY data, but refusa3. may x�equ�re that <br /> the City d�ny the permi� or 1.icense. <br /> 3, The informatian may be shared with othe� 1.oca�. , s�ate ar <br /> federal �genc�.es to �he extent necessary ta process the pe�ni� ar. <br /> �icense. <br /> q. If your req�ested permit or license requires Councii act_on <br /> �o approve, some �nfox-matian may bec�me pubiic. <br /> 5. Xau have certai.n rxghts under M.S. Z3.04 tv review pr�v��� <br /> data on yourself_ <br /> 6. Your ful�. name is required to pracess tihis app�ica�ivn or <br /> pezmi�. <br /> �Gl��/� Sl�iV�t ,� �S S <br /> Fixst Midd�e Last <br /> i y s�� � �s� �y� �= w�- <br /> Address <br /> � S�'=/�a vN �� 7 l� ��s�� � � <br /> City 5ta�e ZiP <br /> y� 3 -��G <br /> Phone <br /> I unders my si ts s stated above. <br /> C� G�� -�".�-- <br /> SLq a�ure <br /> BUILD1iVG 8�ZONIfYG—473•7357 • ADMIN[STRATIOIV 8c FENANCE—473-7358 <br /> t pun�sc wpRKS—a73-�ss9 <br /> ASSES&ING <br />