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� <br /> - _ - <br /> �- � �- ��'��' o� C����T+t� <br /> M! <br /> . post Office Box 66•Crystal Bay,Minnesota 5a323•Municipal Qffices <br /> • <br /> On the North Shore of Lake Minneton a _ <br /> � - • • <br /> DATA PRIVACY A�PIS�RY <br /> 4 Subd. 2, °Rights of subjects of <br /> Tn accordance with M.S. 13.0 , <br /> '- f or a pe'-":^it or <br /> data" , we would Iike to inform you tnat your reques � require <br /> I.icense from the Citn °r��ate or confident aI ini trrnationmay <br /> vou to =urnish ce- �a1 p <br /> You are notified tnat: <br /> used to determine your <br /> 1. The information you furnish WiZZ bee�uested. <br /> qualification for the <br /> Pe��.t or Iicense <br /> 2_ You may refuse to supoly data, but rezusal may require that <br /> L' e�-mit or license. <br /> tne City deny �.ne p <br /> be snared w�th otner I.oca? , s�aie or <br /> 3 . The information may o rocess t'r.e pe=mi� oi <br /> f ecieral. agencies to the extent nec�ssary to p <br /> ?icense. . <br /> �od pe�nit or Iicense requ�r�s Councii. ac��o% <br /> �. �,i your reques�_ become public. <br /> `� approve, scme inforrnation may <br /> � , �ou have certain rights under M.S. 13.0a to rev�ew Briva�e <br /> data on yourself. <br /> 6 , Your ful.1. name is required to proc�ss th's aPPZ'-���'-On °r <br /> pe�it. <br /> ,� ��� �✓� � �A�-�S <br /> �'�� 1 ' +-I+a �- Middle ast <br /> r^irs� �� <br /> � �'I I � � � �`� \ C_��_�C:C�'�_ \_��-��'�� <br /> Address �'_ ��� -� � <br /> � �� �,�� � > <br /> � " State Zip <br /> City <br /> C���- �� � � � - <br /> Phone <br /> = understand my rights as stated above. <br /> � <br /> �,- i � . <br /> , � � <br /> ; <br /> ignature ,� � <br /> �, <br /> !iL'ILDING&ZONING-473-�357 • ADMINISTRATION&FINANCE-473-�358 <br /> • PUBLIC WORiCS -473-7359 <br /> ASSESSIN G <br />