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� <br />� <br /> i� _ , . <br /> � <br />� <br />�r ' �. - ��'��" o� ���I�TO <br />� . . Minaesota 5�323•Municipal Offices <br /> j �� Post Office Box 6& Cr5'S� Bay� <br />� • - <br /> On the North Shore of Lake Minnetonka <br />;� � ` • � <br /> p DATA PRSVACY ��SORY <br />� Subd. 2 , "Rights of subjects of <br />� Tn accordance with M.S. 13.04 ► our request for a permit or <br /> we would like to inform you thof its departments may require <br /> data" , oi prono or any <br />� license from the City rivate or confidential information. <br /> h you to furnish certain p <br />� You are notified that: <br />�ap �, The inrormation you furnish wil.l be used to determine your <br /> 9 �ual ; i=cation for the pe�-lnit or license requested. <br />� u;re tnat <br /> � refuse to supply data, but refusal may req <br /> � 2. You may <br /> den tne pe�i� or license. <br /> a the City Y � �-o or <br /> v be snared with otner local , s�a�.- <br /> 3 . The information mal to process the permit or <br /> federal agencies to the extent necessary <br /> �icense. . • <br /> or iicense requy�Ps Counc�i ac��o% <br /> a, If your recuested Pe�z� uD1ic. <br /> ; ma become p <br /> to aporove, some insormat_on Y <br /> J• <br /> You have certain rights under M.S. 13.Oa to review pr'-va�e <br />� data on yourself. . <br /> k � , <br />� roc�ss �===5 aDD ��ca�_on or <br /> r <br /> c E , Your full name is require �o P <br /> a <br /> per-.nit. <br />; � <br />� � ��� � /� <br />, / , : <br />� �/ � Midd� e �- `i�a� � <br />� r'irst ^� f` /.� <br /> � L�� n � �/ <br /> � <br />� Ad ress ' ,5� <br /> �� � < <br /> � : <br /> �' Z ip <br />� State <br />� �i`�/ �____ <br /> � �j� , j �,� <br />�, - . <br />:�' Phone <br />,� <br />�. I understand mY rights as stated above. <br /> { <br /> � � � -�G� ���� . <br /> " anatur - <br /> ' � <br /> � � PUBLIC WORKS -473-7359 <br /> ' • pDMINISTRAT70N&FINANCE-473-7358 <br /> � BUILD[NG&ZONING-473-i 35� <br /> f <br /> ; ASSESSING <br /> i <br /> � <br /> f <br />