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�r � <br /> . � <br /> ; � ��['�`�' o� ����"O <br /> Post Office Box 66•Crystal Bay, Min�esota 5a323•Muaicipal Offices <br /> ♦1 w � <br /> � On the North Shore of Lake Minn.etorcka - <br /> • - • • <br /> DATA PRSVACY ��SORY <br /> a Subd. 2, "�ignts of suDerm t or <br /> Tn accordance with M-S• 13.0 - . our reQuest for a <br /> data" , we would like to inforlT► You th o f its departmen�S may reQuire <br /> �- o f Orono or any . � nTorma�ion. <br /> license from the Ci �Y P � Vzte or confident-al <br /> you to =urnish Ce=��in r- <br /> oti�ied that: <br /> you are n ur <br /> be used to aetermine yo <br /> i, The in=ormation you furnish wil.l r cuested- <br /> ; or IiCe�Se e <br /> cua?; -ication for t:"1e pe--'-� t � require that <br /> � v re fuse t o s u ppl y data, but reru5z- m�y <br /> 2. ou may license. <br /> deny tne per�it or <br /> tne C1�Y 1oca1 , s�a�e or <br /> �h otner <br /> ay be snared W� �- e?-mit or <br /> 3. The information m a to rocess tne p <br /> federal agencies to the extent nec�ssary P <br /> ?icense. . • a���or_ <br /> n .-c,�yroS C011'_7C�1. <br /> - vou= recuested pe=�1t or lice_.se - <br /> �. �� . �-; on may become Dllt7�ic. <br /> `p �DDZ'OVe� some �niorma`_ • <br /> c Oa to review gr-va�e <br /> - vou h�ve certain rights unde; M.... 13- <br /> J� <br /> azta on yourself. <br /> o th; s appZ=ca�ion or <br /> � 1 na�e is requ=red �o Proc_ss <br /> ( . Your ili- <br /> pe�it. <br /> Middle <br /> :,as� <br /> .^irs� <br /> Address <br /> State Z-p <br /> Ci'-y <br /> � <br /> Phone <br /> I understand mY rights as stated above. <br />� . <br />� � . <br /> , � <br /> - Signature <br /> • pDML*1ISTRATION&FIN.u'�CE-;73-7358 <br /> • PUBLIC WORKS -4�3"�359 <br /> BUILDING&ZONING-473-%357 <br /> ASSESSIN G <br />