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s _ R <br /> -��,. <br /> #�:� F <br /> rt. � °�4T�''�'a��� <br /> `� = �� CITY of ORONO <br /> ..�. �1�:, <br /> .�.� <br /> �.. <br /> :�. <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Mani�P���� <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 /> 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 wi3.l 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 local , s�ate or <br /> � federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense ublic res Councii ac��o% <br /> to approve, some information may become p <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 process this application or <br /> permit. <br /> � , ��� <br /> First <br /> Middle Last <br /> ;7�S"� /�f1 c-'l a,C�, �ia' <br /> Address <br /> � / _��lj .�� � <br /> C'elSili�� ��� <br /> City <br /> State Z1D <br /> ��� — ��L � <br /> Phone <br /> I understand my rights �� stated above. <br /> / � <br /> �GG,� �� .� -��—� .. <br /> S gnature <br /> BUILDING&ZON[NG—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />