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� <br /> ;,,,.., <br /> , � <br /> �:� �-k�� CITY of ORONO <br /> T..:��.�t.�r �. <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <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 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 informatione <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 Iicense. <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 3.icense requires Counci� action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 �o review priva�� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatia:� o� <br /> permit. <br /> �jj;�.�c 1-�nJ,�,�z��:,� SiT�;�� <br /> First Middle Last <br /> 1�EJ���::J 7 S �� ST , �,-l�a S� _ <br /> Address <br /> �-;.tv�—iL C,:�-�.:� ��-��c�.�.�:� ,�„(,,� SS4���: <br /> City State Zip <br /> �f��- s��f Z_ <br /> Phone <br /> I understand my rights as stated above. <br /> � ,-- <br /> G, <br /> S u <br /> " �` <br /> BUILDING&ZONING-473-7357 � ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />