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08i24i94 09:52 THE �ITY OF O�ON� b12-473-7357 003 <br /> r <br /> � <br /> ��'�`��� C����'� <br /> Post Otf1Ce Box 6fi•Crystal say, Minnesota 55323•M�usidpal O�scss <br /> � <br /> � „ � � �n the Narth Shore vf�ake hTin.n.emr�ka <br /> DATA P�ACY ADVISORY <br />� In accordance with M.S. 13.04, Subd. 2, "xights a£ subjects of <br /> data", we would lika to �nfarm �ou that your z���uest for a permit or <br /> l�.cer�se �rom the Gity cf Orono c� any of �,ts degar�men�s may requir� <br /> .you ta furnish certazn gxivate or confzdential information. <br /> you ase no��.fied tha�: . <br /> 1. �h� �.nformation you fuz'nish wi� i be used ta determ�.ne your <br /> $ua�.if�.cat3an far the perm�t or l.icen�e requested. <br /> 2. You may refuse to supply da�a, but r�fusal. may r�qua.re that <br /> the City deny the permit or �.ic�nse. <br /> 3. �he �nformation may be shared with r��her 1.Qca1 , s�a�P os <br /> federal agenci.es te the extent necessary tc proc�ss the permit Qi <br /> �.i�ense. • <br /> q. If you� reques�ed permit ox 3..���ns� ;��cru�.z��w Counail ac��or: <br /> to approve, some �.nfez-ma�ion m�.y b�come pub].ic. <br /> 5. You have Cer�a�.n rights under M.S. 13.04 to rcv:�w px'iv�te <br /> data on yourself. <br /> 6 . Xour fu11 name i5 �equired to pracs5s thi.s application oz <br /> permit. <br /> �11/�LC�iQ��. - z�ast <br /> Firs� M�dale <br /> � �� N�u- � � �6 <br /> Address <br /> � S rl/ �� o-� <br /> Ca.�y Stat� Z�P <br /> � ��� � <br /> Phone <br /> � I underst d my rights as stated abave. <br /> �� . <br /> �.gnature • ' � <br /> de ZO,�fi[VG--4?3�7357 • Al�M���TRAT�dK�FcNANCE� �+�3•7358 • PU9�1C WORKS�473-7359 <br /> StNG <br />