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. � � � _ F . � <br /> � <br /> - �I'�`I' O� OR�1�T0 <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> � � <br /> i ' o + On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of sub erm t or <br /> data", we would Iike to inform you that your request for a P require <br /> license from the City of Orono or any of its departments may <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The inf orm o�i�heY°ermit or li ensebreque ted, determine your <br /> qualification f P <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 shaeces arthto processCthe pe it or <br /> federal agencies to the extent n Y <br /> license. <br /> 4. If yaur requested at1on may become publicires Councii action <br /> to approve, some inf orm <br /> 5. You have certain rights under M.S. 13.04 to review prica�� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatiaa or <br /> permit. <br /> , <br /> r �;/�ti''u /'�/ <br /> � � Last <br /> First Middle <br /> �' � � �� <br /> Ad ress � � <br /> ����� `��� . <br /> City State G1p <br /> ��7� �1��- . . . <br /> Phoine . <br /> I understand my rights as stated above. � <br /> Signature � <br /> BUILDING&ZONING—473-7357 • ADMINIS"IRATION&FIN.�►NCE—473 7358 • PUBLIC WORKS—473-7359 <br /> �ASSESSING <br />