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.._ .- <br /> �-� � � G���" o� ����"� <br /> rl w <br /> Post Office Box 66•Crystal Bay, Minnesota 5a323•Muaicipal Qffices <br /> � - <br /> � - � �� <br /> On the North Shore of Lake Minneton a <br /> DATA PRI�7ACY AD�SORY <br /> "Ri nts of subjects of <br /> g <br /> In accordance with M.S. 13.04 ,�Subd.ou` reQuest for a per:nit or <br /> we would Iike to inform you `h o f its depart:nents may reQu�re <br /> data" , o= prono or any <br /> I. '_cense f rom the City , ; n=or*nation. <br /> ;rou to furnish cer�ain private or coniident�al <br /> vou are notified tnat: <br /> 1. The information you furnisn <br /> will be used to determ'ne your <br /> qualification for the pe'-'�i� or Iicense �equested- <br /> 2, You may refuse to supply data, <br /> but reTusal may require tnat <br /> tne City deny the pe�i� ar license. <br /> be snared w�th other local , s�a�e or <br /> 3 . The infor:nation may to rocess the pe'-�i� ci <br /> f ederal agencies to the extent necessary P <br /> ?icense. , . <br /> � Pe,-;nit or iicense re�ires Counc�l ac-'-or <br /> d. ;L your recues�ed become DllD11C. <br /> `O zpDrOVe� some insor�ation may . <br /> You have certain rights under M.S. 13. Od to rev=ew griva�e <br /> data on yourself. <br /> 6 . Your ful.I. name is required to proc�ss this apol=cation or <br /> per.nit. <br /> , , -� <br /> l <br /> "` Las�. <br /> `�'� ' ddle <br /> First <br /> :� � �� F«n A <br /> AdGress <br /> ,�N �S�? <br /> �1c� � fi � State ZzP <br /> City <br /> �"? ? �1`�'2� <br /> Phone <br /> I understand my ri�ghts as stated above. <br /> -<��%'l F-�/1� ._ <br /> l <br /> Signature <br /> �UILDING&ZONING-473-7357 • ADMINISTRATION&FiNANCE-�73-7358 <br /> • PUBLIC WORKS-473-7359 <br /> ASSESSIN G <br />