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10i18i94 16=26 THE CITY OF ORONO 612-473-7357 003 <br /> � • <br /> �ITY of O�►ON4 <br /> Post Utlict Box 68•CrYetat Ba�y,Minnasots 58523•Maniciv�Offcer <br /> • <br /> � • • <br /> � On the�Yorth Shvre of Lake Minneton a <br /> DATA P�� A�SoRY <br /> zn accordance with M.S. 13.�4r Subd. Z, "Rights of sub7��ts °f <br /> ou that your reQue6t fox a permit or <br /> data^. We would Ii.ke to inform y require <br /> licens� f�am the City of Orono or any of its departments may <br /> yo� to £urnish ceztain private or conf�dentiaZ information- <br /> ycu. are noti�ied that: <br /> ou furnish will be used to de���ine your <br /> 1, The information Y uested. <br /> qual.i�ication for the permit pr licensa re4 <br /> refuse to supp3.Y data, but refusal may xequire that <br /> 2. You may ��it or �,icense. <br /> the City deny the P <br /> 3. �h� inEorma�3vn may b� g�$red with other Iocal , state or <br /> federaz aqencies tfl the extent necessary to proeess the permit or <br /> license. <br /> 4. zf �yd�z requ�stscl permit or license requires Councii act�.on <br /> to appro�e. some information ntay become p <br /> ublic. <br /> 5�.._ You hava certain rights under M.S. i3.04 to review priva�e <br /> data on yourself. <br /> 6, y�ur full name is zequired to p <br /> rocass this appzication or <br /> pexmit. <br /> � "� Las� <br /> Fi.rst Middle <br /> �� �, <br /> - vL ��v�- <br /> Address � >� <br /> S� ' <br /> � Zip <br /> �i,�y Sta�e <br /> � , �a-- �2_� I <br /> Phone <br /> Z understand my rig <br /> hts a e above. <br /> � _ <br /> Signatur _ <br /> BUILDING�20NING—��3•7357 • ADM1NI37RAT10N h FINANC£—473-7356 <br /> • PUBLIC H`ORKS—473-7359 <br /> ASSESSiNG <br />