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� <br /> ��- �, <br /> =�~y`c. � <br /> z�r�., �.._ <br /> ��� �i�{'�� �� ��a�l�� <br /> � � • Post Office Box 66•Crystal Bay,Minnesota 5a323•MunidpaI Offices <br /> -_ � _^ <br /> a ' o a. OR the Norih Shore of Lake��finnetonka <br /> '"-= DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd•our re1uest for a per it or <br /> data", we would like to infor:,1 you that y q <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 noti�ied that: <br /> 1. The in�or:nation you furnish will be used to determine yaur <br /> qua�ification for the permit or Iicense requested. <br /> 2. You may refuse to supp?y data, but refusal. may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may be snared with other local, s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> I.icense. <br /> a, Zf your recuested per.nit or Iicense requires Councii ac��or_ <br /> to approve, some infor.^.iat�on may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your fulZ name is recuired to process this application or <br /> pe�-mit. <br /> ����� 7� �t Z <br /> .--_JI� �� � - <br /> First Midale Las�. <br /> 13�E o �e��-�' �o i � �` Ci �cl � <br /> Address � <br /> m,ac�rV� I'���, n� ss'� 6 - <br /> City State Z1P <br /> (� I � -- '� �� ' 3�/ 3 <br /> Phone <br /> I understand my rights as stated above. <br /> �z��.,� <br /> Signat re �' . <br /> BUILD[NG&ZONING—�73-7357 <br /> • ADNLVISTRATIOr&FIVANCE—�73-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSI�IG <br />