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C' � '` - <br /> � 1 <br /> � * <br /> CITY o� ORONO <br /> Post Office Box 66•Crystal Bay,Minneeota 55323•Municipal Officea <br /> • <br /> � - � a 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 will 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 license. <br /> 3. The inf ormation may be shared with other local, 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 privat� <br /> data on yourself. <br /> 6. Your full name is required to process this appl.ication or <br /> permit. <br /> JO/!'!G3 N O/`/�An VG Y1,SG i7 <br /> First Middl.e Last <br /> �I� 8 ,S/ WG/�i r1 w fo n �c� <br /> Address <br /> /�l� �YI� .s-s.3 9/ <br /> Cit - , . . State Zip <br /> y7.s-o 9p � -. � <br /> � Phone � � <br /> I understand my rights as stated above. . <br /> S nature . . „ � . = . <br /> � � <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION�FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING , _ <br /> _... .r � <br />