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� <br /> C ITY of ORONU <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal O�cea <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 3.ike to i'nform you that your request for a permit or <br /> Iicense from the City of Orono or any of its departments may require <br /> you to furnish certain private or confidentia3 information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your <br /> qual.ification 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 Iicense. <br /> 3. The information may be shared with other local, s�ate or <br /> federal agencies to t�e extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Councii action <br /> to approve, some information may become pub3ic. <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 /> perm't. <br /> . v <br /> Firs Mi dle Las <br /> A dr s <br /> y 9 <br /> City Sta e Zip <br /> �?/ ���� <br /> Phone <br /> I under and my r' ht� as stated above. <br /> � <br /> sM"w*"" <br /> Sl <br /> BUILDING&ZONING—473-7357 • AI)MINISTRATiON 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />