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07i30�93 10:56 THE CITY OF ORONO 612-473-7357 003 <br /> . z <br /> � - c�T� Q� oR�No <br /> x+oec Omce�=ss•c�ysc�� �ay.Minneaota 5�.�?�•MttniaPal Of�� <br /> • <br /> " � _ � � Ott the North Shore of Lake Mir�netottka <br /> DATA PRIYACY A��ISORY <br /> =n accordance With M.S. 13.04, Subd. 2, "Rights of subjects of <br /> ouz �'� uest fvr a permit or <br /> d�ta", �� wou3.d l�.ke to info�'m you that y q requfre <br /> license from thCe ��n p=�atE orr conf dent al inf rmationm�y <br /> you to furnish <br /> yflu a=e notified that: <br /> ],. The information you furnish w�.11 be used to determine your <br /> quaXification for the pQrmit or license requested. <br /> 2. You may <br /> refuse to supp1Y data, but refusal may =equire that <br /> the City deny the permit or 3.�cense. <br /> 3. The inf ormation he extenthnecessaryhtotproc sscthe p r�it °r <br /> federal agencies Ca t <br /> �icense. <br /> 4, If your requeste� permit or license requires Counci3. action <br /> to $pprove, some in£oz�mation maY <br /> become public. <br /> 5. You have certain righ�s under M.S. 13.04 Lo revie� priva}e <br /> data oa youzse3.f. <br /> 6. Your full nam� is required to process this apFlication or <br /> pesmit. <br /> Norman Jensen <br /> James Middle Last <br /> First <br /> 4851 Wellin ton Road <br /> Address <br /> ata MN 55391 State Z�P <br /> City <br /> . �] 0986 <br /> Phone <br /> Z uaderstaad my rights as stated above. <br /> S ature ' <br /> BUILDING 8�ZONING—473-7357 • ADMINfSTRI►TiflN&F[NANCE—473•7358 <br /> • PUSLIC WORKS—473•�359 <br /> ASSESStNG <br />