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r - A►� <br /> + . <br /> � <br /> C ITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 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 wou3d 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 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 iocal , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Zicense requires C�uncil 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 namP is required to process this applicatian or <br /> permit. <br /> G,�E � � LL.�.� �v S-r��o,� <br /> First Middle Last <br /> � �30`� �'F Y ��� -�� � � b <br /> Address <br /> � �, � �, � 2 <br /> City State Zip <br /> 8� 4� �.1��t� <br /> Phone � <br /> I understand my rights as stated above. <br /> Signature . <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINA:`CE-473-7358 • PUBL[C WORKS-473-7359 <br /> ASSESSING <br />