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t <br /> 05i17i95 10:13 THE CITY OF ORONO 612-473-7357 003 <br /> Y o� Q���� <br /> CIT <br /> Yoet OffiCe I3ox 6fi•Cry"tal Bav.��nrsoSe 55323•Munic+Pa1 OfSces <br /> • <br /> Qn the Narth Sho�e�(Lake Mtn�e�n a <br /> � - • • <br /> DATA PRIVACY A��SORY <br /> "��qhts of subject� vf <br /> with M.S. �3-0�. Subd. 2► ermit ar <br /> our Xequest for a P u�ze <br /> xn accordance ou tha� y a��ments maX reg <br /> dat�a" . We would Sik� to infozm Y of xtis dep <br /> the City of Orono or any tiaJ. infoXmat�-on. <br /> IiGgnse from rivgtc Oz confiden <br /> you ta furnish certain P <br /> Xou ax'e noti�ied thgt: <br /> rmat�on Ydu furnish W�-�3eb�euuested , ��termine your <br /> �. Tbe inio e�yti or l�cen� 4 <br /> quali�ication for the p uire that <br /> � dg�a, buti re�usal may Xeq <br /> 2. You may refuse e��ti por license. <br /> t�e city deny �he P <br /> shared w� �h othex 1Qca1 + s�ate or <br /> 3. The in�ormat�on may <br /> be �o process th� pe�"it °� <br /> �ederal agencies �o �he extent ne�essaxY <br /> l�,cense- Council ac��on <br /> ezm�t or Iicense requ�res <br /> 4. If you� zequested p �e��me puhlic. <br /> �o gPP�ove. some �nformation maY Xiv atQ <br /> 5. Y <br /> ou have certa�.n xights under M.S- �3.04 to z�eview p <br /> data on yourse�f. <br /> 5. Your �u <br /> 11. name �s required to process this appl.�cat�-on or <br /> Pe�l�' <br /> S �-�so,� <br /> ��tC��trL C rti�"` I,aSt <br /> Middle <br /> First <br /> ��.��, L . �,.ti����;� � � <br /> �_' C�,: <br /> Rddress �-, �J.� ( <br /> �— �l ti z�p <br /> �`f `' state <br /> Ci�y <br /> � ��-�s�.3 <br /> phone <br /> Z under�t nd lY r�.9hts as sta�e� above- <br /> ;: <br /> � , . <br /> , Sig ature <br /> ��. . <br /> �.. . <br /> �'.~ -_. _ • pO8L1C W4RKS -473-7359 <br /> • � ADMIf`t1S�RATi�N d�FINANCE-473-7358 <br /> gU1LDiNG 8� ZQNING-473-7357 <br /> A55ESS�NG <br />