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• • t <br /> � � ���`�' o� ���1.1T0 <br /> Post Office Box 66•Crystal BaY.Min��'ota 5�323•Municipal O•ffices <br /> M ' <br /> � On the North Shore of Lake Mirinetonka - <br /> • ' • � <br /> . DATA PRS'PACY ��SORY <br /> � "Rights of subjects of <br /> Subd. 2. ermit or <br /> Zn accordance with M.S. 13-ou'that your request for a P uire <br /> data", we would like to inform Y of its departments may req <br /> licease from the City of Orono or any <br /> Y <br /> ou to furnish certain private or confidential information. <br /> vou are notified that: - <br /> he information you furnish CenSebreQuest a. determine your <br /> 1. T e,-m�� or li <br /> aualification for the p u�,re that <br /> refuse to supply data, but refusal may req <br /> 2, You �aY the permit or license. <br /> tne City deny <br /> be snared with othsr local , S�a�e °r <br /> 3, The information may <br /> ta process the permit ai <br /> f ederal agencies to the extent necessary <br /> ?icense. , a���o% <br /> yo e,-mit or license requyses Cou�cii <br /> a, If youi reQues�_d p ublic. <br /> ;nf ormat_on may become p <br /> to approve, some � <br /> - u have certain rights under M.S. 13.Oa to review pr'-v��e <br /> �. Yo <br /> data on yourself. <br /> 6, Your fu11 name is required to process <br /> this apP1=cation or <br /> p e*_�mit. <br /> �o��� ��- <br /> � Lzs� <br /> � Middle <br /> r^irs� <br /> �5 S L.q-N ,� �ltie� <br /> Addres s �S�S� <br /> � State Zip <br /> City <br /> 6/ _ �Y76 - �"7 3S . - <br /> Phone � <br /> I unde=stand mY =ights as stated ab°ne• <br /> gignat r <br /> BUILD[YG&ZO`(ING-473-7357 • ADMlN1STRATION&FIN.�'�CE-'�73-7358 <br /> • PUBLIC wORKS-473-7359 <br /> ASSESSING <br />