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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 /> 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 /> 1. The information you furnish will be used to determine your <br /> qualification for the permit or I.icense 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 /> federal agencies to the extent necessary to p=ocess the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> G . r <br /> First Midd e Last <br /> Address <br /> �i1.t��.1I ��,d ��3���- - - <br /> City State Zip <br /> �9�- -���� � <br /> Phone � � <br /> I understand my rights as stated above. __ <br /> .�. _ _. <br /> Signature _ ._: . - ' . <br /> BUILDING&ZONING-473-7357 • ADMIIYISTRATION�FINANCE-473•7358 • PUBLIC WORKS-473-7359 � <br /> ASSESSiNG _ ` <br /> I <br />