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� <br /> CITY of OROl\TO <br /> Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Officea <br /> i <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 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 3icense. <br /> 3. The information may be shared with other I.ocal, 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 private <br /> data on yourse3.f. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> �c�i r <br /> First Middle Last <br /> �s`T �r� /'--�2 S <br /> Address <br /> S�.T �is ✓-a r1c �/�, ss�/�� <br /> City State Zip <br /> ��� ��v �3�y <br /> Phone <br /> I unde stand my rights as stated above. <br /> c /%�� � <br /> Signatur � <br /> BUILDING&ZOIYING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />