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, <br /> s. , . 1 <br /> . <br /> � Olf oRONO <br /> CITY <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <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 sub er�t or <br /> data", we would like to inform you that your request for a P require <br /> license from the City of Orono or any of its departments may <br /> you to furnish certain private or confidential information. <br />� You are notified that: <br />- 1. The inf or fo lthey�ermit or licensebrequested, determine your <br /> qualification P <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 ot rocesscthe pe�it �r <br /> federal agencies to the extent necessary to p <br /> Iicense. <br /> 4. If your requested permit or Iicense requires Councii actior. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6. Your full. name is required to process this appl.ication or <br /> permit. <br /> � �� <br /> ��G� / O� <br /> First <br /> Middle Last <br /> 5���� C��,� � <br /> Address �� a�� <br /> �� J <br /> `�%?�j�tiG r�s�' i��� <br /> City State Zip <br /> �.�' y� 08 �� <br /> Phone <br /> I u ers rights__as stated above. <br /> gna re ' <br /> BUILDING&ZONING—47 -7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />