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- � . <br /> .�.�. . <br /> �u��:�,� ,� . <br /> ,;� ' <br /> ��.�� ��-,3k, ��� <br /> �a;t�r,,., � �} � <br /> :�:.� ��---.�t�:�� �� - �i��� O� � <br /> y s���,�-,� <br /> L ���g�,'�^; . <br /> "�*' <br /> �w�'µ Post Office Box 66•Crystal Bay,Minnesota a-i323•Municipal Ofnces <br /> , s � _ <br /> � , _ � a-.; On the North Shore of Lake l�linnetonka <br /> DATA PRIVACY 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 will be used to determine your <br /> qualification for the permit or license 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 iocaZ , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested perr.iit or Iicense requires Councii. action <br /> to approve, some inf ormation may become public. <br /> 5 , You have certain rights nnder M.S. 13.04 to review pri�at� <br /> data on yourself. <br /> 6. y�ur full name is required to process this applica�ian or <br /> permit. <br /> First <br /> Middle Las� <br /> Address <br /> City <br /> State Zip <br /> �44 �073 . <br /> Phone . <br /> I understand my rights as stated above. <br /> � Z� _ . ` <br /> Signa re �� <br /> BUILDING&ZOlY1NG—473-7357 • ADMINISTRATIOy&FIN�`10E—�73 7358 <br /> • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />