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i <br /> , . I <br /> . � <br /> CITY of ORONO <br /> ' Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal O�ces <br /> • <br /> � . � � On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would la.ke to inform you that your request for a permit or <br /> license from the �ity of Orono or any of its departments may require <br /> you to furnish cerjtain private or confidential information. <br /> You are noti�ied that: <br /> 1. The information you furnish will be used to determine your <br /> qualification for the permit or Iicense requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or license. <br /> ' 3. The infqrmation may be shared with other Iocal, state or <br /> federal agen�ies to the extent necessary to process the permit or <br /> license. �� <br /> 4. If your requested permit or Iicense requires Counci3. action <br /> to approve, ome information may become public. - <br /> 5. You havi certain rights under M.S. 13.04 to review private <br /> data on yourjself. <br /> 6. Your ful.]. name is required to process this applicatian or <br /> permit. <br /> :�G�kU`li�--� � <br /> First Middle Last <br /> � ��a !o ��' <br /> Address <br /> r , <br /> �� <br /> City j State Zip <br /> L1�(ri` L���v� / <br /> Phone <br /> 2 understand my rights as stated above. <br /> Signature . <br /> BUILDING&ZONING-47 3-7 35 71 • AD!biCYISTRAT'ION&FINAIVCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br /> I <br />