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10i18i94 16:26 THE CITY OF ORONO 512-473-7357 003 <br /> C ITY of ORONf� <br /> Post Uftice BoY 68•CcYetal Bay,I�finnesots 55323•Manici�el Offices <br /> • <br /> � • � • <br /> Qn the North Shore af�ake Minneton a <br /> DATA PRIYAC7C A��1ISORY <br /> In aacordance with M.S. 13.04r Subd. Z, "Rights of sub er it or <br /> data^. We wau1.8 Ii.ke to inform you that your requegt for a p requi�'� <br /> license f�om the City of arono or any of its departments may <br /> you to furnish ceztain private or conf�denti�-a�- information. <br /> you are notified that: <br /> l, The information you furnish wi1.1 be uue� t�o. determine your <br /> qualification for tha permit or license req <br /> Z. you may refuse to supp3.Y datn� but refusal may require that <br /> the City deny the permit or license. <br /> 3. The informatiion may be shared with other localr state or <br /> federaz aqencies to the extent necessary to proeegs the Pem`it ar <br /> license. <br /> 4. zf your request�d at�on may be ome pub 1 c�es Councii ac�ioa <br /> to apg=ove, some inf orm <br /> 5, You have certain rights under M.S. i3.04 to review priva�e <br /> data on yourself. <br /> g, Your full name is required to process this application or <br /> pezmit. <br /> h //� f�r�� ��'u��/�-/� ' <br /> �C � Middle Last <br /> Fi.rst <br /> ��C,D_ � ����17��� /,,ar�� <br /> Address �G�� <br /> �/ �����-� �'y���' .� <br /> Ci y <br /> Sta�e Zip <br /> -(����� � <br /> Phone <br /> I understand my rights as stated above_ <br /> , � �� <br /> � �� <br /> S1 ature <br /> BUILDtNG�ZONING—a73•�357 • ADMINISTRA7tON.t FtNwNCE—4�]-7358 <br /> • PUBLIC WORKS—473-7]59 <br /> ASSESSING <br />