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� � �� <br /> � <br /> �.��. �� �, . <br /> . � , <br /> - CI�'I' of ORO�TO <br /> Post Office Box 66•Crystal Bay,Minnesota 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 would 3.ike 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 local, state or <br /> federa.I agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense 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 yourseZf. <br /> 6. Your full name is reguired to process this appl.ication or <br /> permit. <br /> ,/�c�E -Jo r�l�/ �i� 2 [So� <br /> First Middle Last <br /> �C� 7 �S I-1�i��"D��)� �v� �S� <br /> Address <br /> � �C S ��I�-� �~-S `� � � <br /> City State Zip <br /> 4Zz_- � o3s� - " <br /> Phone <br /> I understand my rights as stated above. <br /> ignature . ' <br /> � , <br /> BUILDING&ZONiNG—473-7357 • ADMINISTRATION Fc FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br /> I <br />