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.. �, • ._. <br /> � <br /> CITY of UROl�TU <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � - � � On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADPISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would Iike to inform you that your request 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 /> 1. The information you furnish will be used to determine your <br /> gualification f or 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 locaI., state or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <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 pri�a�� <br /> data on yourself. � <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> S�'J�-� � <br /> First Middle Last <br /> �v�'f /"e n /7 �Uc � � <br /> Address <br /> ,f� �G�'? �-"/`� � I?�1 !�! �"J�`��-3 <br /> City State ZiP <br /> ��� --�67� <br /> Phone : <br /> I understand my rights as stated above. <br /> � <br /> gn re . <br /> BUILDING&ZONING-473-7357 • AD!NINISTRATION&FINANCE-473-7358 • PUBLIC WORIFS-473-7359 <br /> ASSESSING <br />