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� <br /> � <br /> t <br /> � oRONo <br /> CITY of <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal 4ffic� <br /> • <br /> � � � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would like to inform you that your request for a permit or <br /> Iicense from the Citn o r�ate or confidential e nfo ationmay require <br /> you to furnish certai p <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your <br /> quaZification for the permit or Iicense requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may be shared with other local , e�i� or <br /> federal agencies to the extent necessary to process the p <br /> license. <br /> 4. If your requested permit or license requires Councii ac��or. <br /> to approve, some information may become public. <br /> �. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6 , Your full name is required to process this application or <br /> permit. <br /> �E� � ��� <br /> Fi st Middle Last <br /> �S'?� L�v�� S ,� A��S� <br /> Address <br /> � ?�. ,J �3G}'� <br /> City State Zip <br /> -�-� �-� � �� <br /> Phone <br /> I understand my rights as stated above. <br /> S � <br /> BUILDING�ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />