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,� � <br /> . ' � <br /> . "'t <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 PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would like to i,nform 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 wil.l 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 i.ocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or 3icense requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�at� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ,,��1� ..DA t,�� /�f...��U R��R f <br /> First Middle Last <br /> .��.�10 2�s� �r ��.J' <br /> Address <br /> � �c�Iv C� /`'r �C.> .�S'3 C'� � <br /> City State Zlp <br /> �S/�� -�o�o <br /> Phone <br /> I understand my ri t s stated above. <br /> � <br /> � . <br /> S gnature . <br /> BUILDING&ZONiNG-473-7357 • ' ADMINISTRATION&FINANCE-473-7358 • PUBL[C WORKS-473-7359 <br /> ASSESSING ' <br />