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- �` j <br /> � � <br /> CITY of ORON <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 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 /> l. 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 pe�mit or license. <br /> 3. The information may be shared with ot rocesscthe permit ar <br /> federal agencies to the extent necessary to p <br /> Iicense. <br /> 4. If your request�d permit or license requires Councii ac�ior. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> � .�- � r�J �� �3��/ <br /> First <br /> Middle Last <br /> ���5 ��d2� ��F" i�s2 i v� �o � S Z� <br /> Address . f���4�� <br /> !`� �ll� ��� g"� <br /> Cityl y State Z1p <br /> ��/' O ��' � <br /> Phone <br /> , <br /> I understand my r' s tated above. <br /> Signature � � <br /> BUILDING&ZOIYING—473-7357 <br /> • ADMINISTRATiON&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />