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� <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <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 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 /> l. The information you furnish will be used to determine your <br /> qualification 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 license. <br /> 3. The information may be shared with other local, s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> I.icense. <br /> 4. If your requested permit or Iicense requires Council ac�ion <br /> to approve, some information may become pub].ic. <br /> 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6. Your ful.l name is required to process this appl.ication or <br /> permit. <br /> �°�-�G� �oh,� ,�//1 <br /> First Middle Last <br /> S8s' ��a w� ,�/ �a . - <br /> Address <br /> �� � �S3SC <br /> City State Zip <br /> y�s �3 yC <br /> Phone <br /> I understan my right s stated above. <br /> Signature <br /> BUILDING 8c ZOIYING—473-7357 � ADMINISTRATION.t FINAIYCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />