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. <br /> �, . <br /> � . <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 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 3.ike 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 license 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 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 priva�� <br /> data on yourself. <br /> 6. Your full name is required to process this� application or <br /> permit. <br /> IKa�� �e NC.�t� LS�-�.i I�L��21� <br /> First Middle Last <br /> Z[77 �f-tAr'��W"�r7 �t� <br /> Address <br /> W�Y z���. n�t�r ���� � r <br /> City State Zip <br /> �7r 7r��� <br /> Phone - <br /> I understand my rights as stated above. <br /> �� - �jQ , <br /> Signature <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBUC WORKS-473-7359 <br /> ASSESSING , <br />