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• ! <br /> (\‘‘.- . <br /> CITY of ORONO <br /> CITY Post Office Box 66•Crystal Bay,Minnesota 55323•Munidpul Offices <br /> OF On the North Shore of bake innetonkce <br /> ORONO <br /> DA'T'A PR=VAS ADVISORY <br /> subjects <br /> In accordance with <br /> M.S. 13.04, Subd. 2, "Rights of a permit of <br /> r <br /> data", we would like to inform you th of yourat request forts departments may req <br /> license from the City of Orono or any uior <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The information you furnis willebeeue se ded t.determine your <br /> qualification for the permit or <br /> 1 data, but refusal may require that <br /> 2. You may refuse to supe Y <br /> the City deny the permit or license. or <br /> 3. The information may be shared with other <br /> ocal, state statepermit or <br /> federal agencies to the extent necessary t <br /> license. <br /> 4. If your requested permit or license relic res Council action <br /> t <br /> • <br /> to approve, some information may bac p private <br /> 5. You have certain rights under M.S. 13.04 to review p <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> I c', <br /> .m_ - M dale a act <br /> First 02 <br /> -v <br /> Address tate ��-30,� <br /> ' . _ ( •_- PIN Zip <br /> State City . <br /> Hca- a<3 - -(4I <br /> Phone ' <br /> ' rights as stated above. <br /> I understand my . <br /> I' <br /> / 40011 ' <br /> gn7" urs /.� <br /> BUILDING4 ZONING-413 7347 • AOM INIS CRnT10N A FINANCE-•473-7358 • <br /> 1, <br /> PUBLIC WORKS-473.735• <br /> ASSESSING <br /> .-",r, I rn l f^I . ern nunLn Art 1 1 7•. 7u 1 OT•Gfi 7G iJ Ll iJ f1 <br />