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� <br /> � � �' "�"Y Of OR01T0 <br /> CI <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <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 /> Iicense from the City of Orono or any of its departments may requi=e <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The inf orma�Ti�heY°ermit or Iicensebrequested. 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 Iicense. <br /> 3. The information may be shared with other �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 Councii action <br /> to approve, some information may become public. <br /> 5, You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Yaur full name is required to process this applicatian or <br /> permit. <br /> �,�..� Vv. W�L�� <br /> First Middle Last <br /> 1�EZo� p/�r.�.r2� � � <br /> Address � <br /> City State Zip <br /> �3 �- C � � <br /> p:�one <br /> I un and my rights as stated above. <br /> �� <br /> Vv <br /> Signature <br /> • ADMIlVISTRATION&FI�IANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> BUILDING&ZONING-473-7357 , <br /> ASSESSING <br />