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` - � ����' o� ����'� <br /> Post Office Box 66•Cr5'stal Bay.Min�esota 5a323•Municipal Qffices <br /> N! � <br /> � " <br /> On the North Shore of Lake Mirzneto a <br /> • - • � <br /> DATA PRIVAC� ��SORY <br /> a Subd. 2 "Rignts o� subjects of <br /> ce with M.S- 13.0 - . ` ermit or <br /> -rn accordan `hat your request f�r a P reQu; re <br /> data", We `aouZd 1=ke to inform o°�ny of its departments may <br /> from tne City oz Orono ; aent�al =n-o��t=on. <br /> license � r; vate or conf- <br /> you to furnish ce-��1n p <br /> vou are notif=�a tnat: <br /> �=ormation you �urnish wil.l <br /> be used to deLermine you'-' <br /> 1. The i_ • L Ce:�se recues�ed- <br /> cual;'ication ror the pe''�=� or Ii <br /> You may re�use to supply data, <br /> but re�usal may requi,-P that <br /> 2. �- license. <br /> tne City deny tne permi� or <br /> snared with otner local , s�a�e or <br /> "orznation may be roc� pe�it �l <br /> 3 . The in- <br /> �. ss t e <br /> f ederal agencies to the ex�ent necessary �-o P <br /> ?icense. . ; ac��o% <br /> or iice:�se =e�'sir`=S Counc_i <br /> a, �i you� recuested Pe=111� bec�me p ' ; <br /> , ma ub��c. <br /> �o aporove, some insormat_on Y . <br /> ; ts under M•S• 13. <br /> pa to rev�ew pr_va�e <br /> J• <br /> You have C@'_"Ldli1 r-gn <br /> data on yoursel=• • <br /> �-o rocess t:�s ZDDI-'_ca�=or� or <br /> 6 . <br /> Your full name is required � P <br /> pe�it. <br /> _ <br /> � ' � _ , / <br /> �� �'�C-� �;.,,�_ ;-,�- ;�,-� �_c_ ��/�-' Las� <br /> Midd�e <br /> ===st ;�% <br /> - (, ��, = � �� i�� - �� <-r i <br /> `� , � �/� <br /> nQCreSS � �-� �;' "� /;: <br /> / ' - <br /> ,-, <br /> � � /� _� ,�i Zi� <br /> _ s`Z�e <br /> CiLy <br /> � <br /> /� '� i _ C c_� ,r:- % <br /> Phone <br />: <br /> = understand mY rights as stated above. <br />. ___ _ , <br />� ;\ � - <br />� � � � � �"; � ����� � �� �-- - <br />� �_ ��"- � � �� � �\-�--�. i � � . . . <br /> � � , <br /> Signature . <br /> � pDMINISTRATION&FiN.��E-;73'�358 <br /> � PUBLIC wORKS-473-7359 <br /> BUILDING&ZO`r1NG-473-7357 <br /> ASSESSIYG <br />