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� . , <br /> � <br /> CI'�Y o� ORONO <br /> Post Office Box 66•Crystal Bay,Minneeota 55323•Municipal Offices <br /> • <br /> • - � • On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we wou3.d like to inform you that your request for a permit or <br /> Iicense 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 wi3.1 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 I.icense. <br /> 3. The information may be shared with other Iocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Council. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> D�o�v � 7"l¢�°�' ��' <br /> First Middle Last _ <br /> _ 3��° sa � �y io � <br /> Address <br /> � �h�� <br /> Cit State Zip <br /> �� 3����� <br /> Phone <br /> I understand my rights as stated above. <br /> � <br /> Sig ature , <br /> BUILDiNG&ZONING—473-7357 • ADMINISTRATIOIY&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING , <br />