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f - � <br /> � � <br /> �I�C`� o� (��+C�I�(�► <br /> Post Ufficr. }3ox FG•Cryatt�i Bay,MinneAata 5537..3•MurriCipal Qftices <br /> � <br /> + ' � a Qn the Norih Skore of Lake Min�tet�nka <br /> DAT14. PRIVAGY d�DVSSORX <br /> Xn accordance with M.S. �3.04, Suhd. 2 , "Right:� df suhjects o� <br /> d�tia", we woul.r� �.ike to inform you that Xour request far a permit or <br /> licensE fzom �he Ci.ty o:E Orano ar any �f �.�� departments may requixes <br /> yau to furnish certgin private ox con£iden��al intoxtnation. <br /> �tvu are no�if��d �hat: <br /> 1. The infvrmgt�.on you fuxni.sh w�ll be us�d ti� d�tiermine your <br /> quali.fi.cation �or the pez-mi.t or �.�G�nse requested. <br /> 2. You t��.y re�use ta supply data, buL- re�usal. may x�c���-r� '�hat <br /> the C�.ty d�ny �he permit a�' xicense. <br /> 3. The informatian may b� shared with othe� 1.dca�. ► s4�te °�' <br /> tederal ager�cies ta the �x�en� n�cessary �a p�'ocess the perr�it or <br /> �icens�. <br /> 4. If your �equest�d permi�� or �iGense requzz�s Counc�.� aa�.ion <br /> to appx�y�, �ome informa�.ion may b���me publ.i.c. <br /> 5. Ycsu ha�re c�r��in zights una�x M.S. 13.04 ta review pr�.va�e • <br /> da�� an ��ourse�lf. <br /> 6 . Your ful.l n�ne is z�equxr�d �o prc�cess this appl-�.catiori os <br /> p�rntit. <br /> �.►����� <br /> �� � ���� <br /> F�r��, Mi.ddle Last <br /> C���� ,��� ,��, � � <br /> Address <br /> C,u�r���-�� �_ ����� - - <br /> City . S#:at� �1P <br /> , � <br /> '�� �/`�".�. li �� <br /> l�hone <br /> Z undex��Gand my r�.ght�s as stat�d above. <br /> �.,_ �. <br /> gnature � <br /> BU1L[71NC dt zaN�NG-47�•y35y • ADMlNtg7RArtON dr FINANCE-a�3•7358 � rUSGfc woaxS�473-7359 <br /> A55ES51N G <br />