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CITY of ORONO <br /> i'" Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <br /> `i _,,� <br /> � � • s�.�` On the North Shore of Lake Minnetonka <br /> F;ATR PRIVACY ,ADVISORY <br /> lIl ��CCG?-Ci.�i)C;c. bJ: t�i i'"1 .:� , i�) . .l��i � v`i�.1CjF1�S Ot Sid'S7]P�e.:�:S �t t�Gi�ds� � <br /> 4�r� wc.�ulc� 1zk� to i�frrm yotz th�t your �equest �or a permi� ar <br /> I.ic�:�se f_r�m the Ca.ty of Orono or any of its departments may <br /> �equire yot� �.o f�rr�ish c�rtain �riva�:e or confidential ir�form- <br /> atian. <br /> You are notified th�t : <br /> �. . The inF�rrnation yc�u f�srrli.s�i will be ��sed to detern�ine <br /> vo�ar c�ualif�cat�on for the p�rmit or license reqizested . <br /> z � Xc�u may ref°ase t� supply �ata, but r�fus�l may requ�.re <br /> t�hat the Ci�y cieny the permit c�r license . <br /> 3 . �'�e information rnay be si�ared with otl:er local , state <br /> os fed�ral agencies �o the exten�t r�eces�ary to process <br /> �he �ermit or 3.ic�nse. <br /> �t . Ify ouur req�ested permit o� license reqires councig <br /> ��ction �o apFrov�, some ingormatfan ��� becom� pub�ic, <br /> 5 . �'ou have certian rig.zts under ��1�S . 15 . 16 5 to review <br /> �:�rivate data on yourse3.f . ` <br /> t; . Your fui7. r�ane , and c�ate of birth -v.re .requ�.r�ct �a pi:c�cess <br /> t.his apn'.a..ca�ri:_,r. or ne._rni.�.. <br /> '��'���- �'� --- t�� .M.r. ,c��`-=/..t',.�.�.i:_� —_._...�__ <br /> i i.�'St f`�l1C�C�1�, �t3�ty <br /> �"��__y.J�—.{�/��{l'L..C;;s /� Li l <br /> F�ddress <br /> �.��-�-��Z.w�� --- <br /> ���te o birth (do�s no� ��ply �o building/gener.al g�rmi�.s� <br /> �-��_� } `_ � <br /> �_��. �l _ . <br /> I�horae <br /> ? underst��nd my x-�.g��::� �zs �t�t�d abo�.�e . <br /> X ��."''�e�-� s.-� �. <br /> Sir,nature <br /> Bl'ILDING&ZONING— 473-7357 • ADMINISTRATION&F(NANCE —473-7358 • PUBLIC WORKS—473-7359 <br /> ASSE?SSING <br />