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♦ <br /> . _ ,/�. <br /> �� . <br /> ?�,'�� ;� : ' <br /> �i 1.* .'. y <br /> t. � <br /> k `�rti���(� '�� � <br /> y ,:.,,� �i g�� O� o��� <br /> f �:9��`�"�..� fw.�'tr`"4��. ' <br /> G�� �_•.4F:. <br /> ��,�-�_ ' ,�„�� _..: <br /> �^ Post Office Box 66•Crystal Bay,Minnesota Sa32:i•Municipal Offices <br /> ��r:l..= <br /> - -'`.,,, ! <br /> ; � _ v � On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2, "Rights of subjects of <br /> data", we would Iike to inform you that your request for a permit or <br /> Iicense from the City of Orono or any of its departments may reguire <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 license. <br /> 3. The information may be shared with other iocal, state or <br /> federa3. agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Yaur full name is required to process this applicatian or <br /> permit. <br /> �' <br /> � �� � <br /> rst Middle ast <br /> �� � c ? ✓ <br /> Address <br /> .����c s;� /%rr,�� .�``53h�� <br /> City State Zlp <br /> , <br /> ���-��J� �i�) �'�?��//�l ���v� <br /> Phone <br /> I understand my rights as stated above. <br /> �,�; l-�/ ,c'` <br /> ignature <br /> , • PUBLIC WORKS—473-7359 <br /> BUILDING&ZONING—473-7357 • ADMIlYISTRATION&FINANCE—473-7358 <br /> ASSESSING <br />