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. , . � <br /> � <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Offices <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 /> da$a", we would like to inform you that your request for a permit or <br /> license from the City of Orono or any of its departments may require <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> 1. 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 information may be shared with other �ocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Counci3 action <br /> to approve, some information may become public. <br /> 5. �'ou have certain rights under M.S. 13.04 to review pri�a�e <br /> data on yourself. <br /> 6. Yaur full name is required to process this applicatian or <br /> permit. <br /> �- <br /> ��,,e,,�,,,,�,,�5 . ..�-- i �,1� <br /> First Middle Last <br /> �1 ��� �� � <br /> Address �, <br /> �'C�°� � ✓I'ln'� — �3�S <br /> City State Zlp <br /> O . ������ � <br /> Phonje <br /> u ers my ghts as stated above. <br /> . . <br /> a u <br /> BU�.DING d!ZONiIVG—473-7357 • ADMINISTRATION at FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING ' <br /> � <br />