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��: : <br /> � ;> <br /> � �� <br /> �`.�,� '�, � .��_ �r <br /> Kr��� t ��_;,. <br /> �.� �� �.��. <br /> � ��� �� � �:� � C�'�'� Of ����1T� <br /> �t ��� <br /> K�. <br /> �: � : <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> �.�,���i � <br /> � <br /> >�.�`' <br /> "�y - ' '; 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 /> 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 /> qual.ification 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 , s�ate 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 actior. <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 /> .� • � ��� � - <br /> ���� ��-�� f � <br /> First Middle Last <br /> � � <br /> � ���Q/ �� <br /> ���L� � ��T�l/'1� y-������ <br /> Address <br /> .� � � ��`�. � <br /> City State Zip <br /> ���� ���; ���- <br /> Phone <br /> I understand my rights as stated above. <br /> a �7 <br /> S' g at r <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE —473-7358 • PUBL[C WORKS —473-7359 <br /> ASSESSING <br />