Laserfiche WebLink
� __ 10i18i94 16:26 THE CITY � pR�Jp 612-473-7357 <br /> 003 <br /> � • <br /> C ITY of oRONO <br /> Fost Of'ftR BoY 68•Cryee�►B�y.MinnMou 5.'S.7z8•Manicip.�1 Ot'Rce� <br /> ! . � � On the North 9hort of Lake Minnetonka <br /> DATA PRIYACY AVVISoRY <br /> Od, Subd 2, "Righta of subj�cts vf <br /> zn �ccordence with M.S. 13. • <br /> d�ta", we wou].d like to inform you that your request for a permit or <br /> �ou et� fur ish ce t in p ivate or confident al informationmay zequire <br /> Y <br /> Xou are notified thatz <br /> 1. The in�ormation you furnish v+il.l be used to det�rmfne your <br /> qua�.ification for the permit or liaense requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> ttte City deny the pezmit or license. <br /> 3. Tbe intorma�ion may be shared with other local, stats or <br /> Eederal agencies to �he extent necessary to process the pez�it Qr <br /> liCense. <br /> 4. �f yOUX requ�st�d permit or 1.icense requitec Councii action <br /> to appzove, some infozmation atay become puh�.ic. <br /> 5. You bave certain zights under M.S. 13.04 ro zeview priva�Q <br /> data on yourse.Ii. <br /> g. ydur fuli name is zequired to px'ocess �his application or <br /> permit. <br /> Y�' � � �G�� <br /> F�rS Mid Xe I�ast <br /> �� �� ���� �� � � �a .t _ <br /> Address <br /> `� 5.�.�.�� <br /> ��.�Y State Zip <br /> �7Cp � 0 `� � <br /> PhonQ <br /> I undsrsta�nd my riqhts as sta�ed above. <br /> �.qnatiure <br /> �UILDtNG/L 20NtNG—�73�7357 <br /> • ADMINI57RA7tON�flNANCB—473-7]SR • PUeLIC WORKS—473-7�l9 <br /> �ss�ss�Nc <br />