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v � <br /> �� ��� �� <br /> '��� CITY of ORON(� <br /> �� �� � ��- � <br /> � �� 4 -� <br /> �� � � �: <br /> A�� _�� <br /> �r. Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> -'���"�%'�F <br /> .� �� ��� <br /> �'=t{� �"� ` On the North Slzore 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 3.ike to inform you that your reguest for a permit or <br /> Iicense 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 Iicense. <br /> 3. The information may be shared with other local , s�a�e or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense requires Councii act�or. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to rev�ew private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ��10 nc� I ��1,�e., <br /> First Middle Last <br /> « b a �1-���oo� �c�d <br /> Address <br /> �� ����, <br /> City State Zip <br /> ��ll' �g�� <br /> Phone <br /> I understand my rights as ted above. <br /> . <br /> Signature <br /> BUILDING&ZONING—473•7357 • ADMINISTRATION&FINANCE — �73-7358 • PUBL[C WORKS —473-7359 <br /> ASSESSING <br />