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. 10i11i94 14:40 THE CITY OF ORONO 612-473-7357 0�3 <br /> � <br /> GI�Y of U�1��.1T(� <br /> 1'oat Otilce Box 66`Gryatal Bay,Minaesota 55323•Munitipai Qfficee <br /> • <br /> + . � � QR the North Shore af Lake Minnetottka <br /> DAT1� PR�VACY ADV�SORY <br /> xn accordaace wf�h M.S. Y3.D4, Subd. 2, "Righ�s of subjects of <br /> data", we wduld l�.ke to �nform you �hat your request for a permit or <br /> license ��com the Cxty df Orono or any of its dep�rtments may zequire <br /> you td furna.sh certain pr�vate ar cc�nf identiaZ informa�.�an. <br /> YQu are notif�ed that: <br /> �.. The �nfarmatian you fuznish w�3.� be used to detearm�.ne your <br /> qua].xfi�a�ion �or the p�rmi� ar �icense requested. <br /> 2. You may xefuse to su�pl.y data, but refusa3 may requ�r� �ha� <br /> the City deny the perm�t vr �.icense. <br /> 3. Th� informat�.on may be shaxed wi�h v�her loca3. , s�a�e ox <br /> £ederaZ agencies to the �x�ent necessarY to process the p�zmit pr <br /> �.ic�nse. <br /> �, T� your Xequested �erm�.t ar �.���n$e requires counci:� actian <br /> ta apprc�ve, some informativn may become �ub�ic. <br /> 5. You have cexta�n xa.gh�s under M.S. 13.04 ta r�v=�w �riva�e <br /> data cn y�ursel�_ <br /> �. Youx fu3.1 name is xequired to pracsss thi� appl.ica�ion o� <br /> � permit. <br /> -��-C�/' /1�, ''.�C� �� ' � <br /> FirS� M�dd�e �.as <br /> � � �� � ��, 7�� �Y� �C� � <br /> Addresa <br /> , � n r I ��-%/J <br /> ' G�� �y' y'� � �'I/t/` �-� <br /> Cxty tate z�P <br /> y�- �C� y Y ,,, ,1;�� �� <br /> ' Phone �::. �° �: <br /> ,�,_r <br /> u,.� � � <br /> +.k �ti I <br /> Z uud�xatassd� my Zight�s as stated above. Y:6 ,t � <br /> , /� _,f--.__ ` : �'��k������ � ;r��.. <br /> � y +� y r <br /> � �� � ��'�///�IN"V L/�� . . �k� �.�fJ4�'i�a�j � ��. <br /> . 6 �.�`'rn' <br /> �gnature �,.�� �,� <br /> . ' p Y�i '� It i. .�' il I <br /> . "u�4�f'e�r .�'Fif�' .�,t' I ����,�i� I'f, <br /> i .^� �€ <br /> �I�♦��.�.i��i6������y�� —�r'�'�' � ��►t�—473��1f� � , ,�5y,�� ',�y,��t�!'�, �;3� wa`� ' <br /> f1JJbJ�/i��v �! � e4i4v T�xh �'�,y�£'�a�{.S; 4 ��M{� '� <br /> . . - '�3�;� _'� <br /> � � . � _ . .. .�:...w.�... <br />