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.' <br /> � <br /> � ��'�`.�' o� ����TO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Muaicipai Offices <br /> • <br /> • - • • <br /> On the North Shore of Lake Minreeto a _ <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.Qur re1uest for a permit or <br /> data", we would like to inform you thQ f its departments may require <br /> license from the City of Orono or any <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> l. The inf ormatiohey�erm t or li ensebrequested. determine your <br /> qualification for t 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 shared with other local, s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4, If your requested permit or licease requ�res Councii ac�ior. <br /> to aporove, 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 procsss this application or <br /> pe*znit. - <br /> , � � `Tp�J'�c?�h ���►"��r� <br /> !- - - �� Middle Last <br /> Firs <br /> Zf� 6 <br /> Address <br /> � �� �J-�Cf <br /> City <br /> State Zip <br /> �I Z- ���-3�3 8 <br /> Phone <br /> I understand rights as sta above. <br /> Sign ure � ' � <br /> � • PUBLIC WORKS—473 7359 <br /> BUILDING&ZONING—473-7357 � ADMINISTRATION&FINANCE—473-7358 <br /> pSSESSING <br />