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� ti <br /> �. <br /> a�� �- �N� <br /> TM��;.: CITY o� OI� <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•H4uniciPal 0��� <br /> • <br /> � _ � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVIS�RY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of sub er�t� o� <br /> d a t a", w e w o u l d l i k e to inform you that your request for a p <br /> license from the Citn o r�ate or onf dential e nf rmation m a y r e q u i r e <br /> y o u t o f u r n i s h c e r t a i p <br /> You are notified that: <br /> l. The information you furnish will. be used to determine your <br /> qualification for the permit or license 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 i enciestto the extenthnecessaryhto processcthe permit or <br /> federal ag <br /> Iicense. <br /> 4. If your requested permit or Iicense u�equC res Councii ac�io% <br /> to approve, some information may become p <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> pe?�mit. <br /> / � <br /> � � �-_ -� �. � <br /> ���ci �`�. <br /> First <br /> Middle Last <br /> c � S h'� �,?�- %�l': <br /> 3 ';�< <2'. � <br /> Address <br /> % ,--- ���' �' s" �y/ <br /> �',� �/�- z iP <br /> City State <br /> "7` ��� , �., ->�; <br /> ;� <br /> Phone <br /> I understand my rights as stated above. <br /> , � �� <br /> C , <br /> /T", <br /> CJ ��- riL� �1-Z'1 <br /> S ' nat re � <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />