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�, . <br /> .,,,�,�W, `3''``f�; ,<� <br /> � ��ry��.�:� r� <br /> .���`���T� �i� 1� O� ���N� <br /> ����� <br /> .-�.�. <br /> +��� . Minnesota 55323•Municipal Offices <br /> Post Office Box 66 Crystal Bay, <br /> ! <br /> � _ � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVIS�RY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of <br /> data" , we would I.ike 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 wi13. be used to determine your <br /> qual.ification 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 3.icense. <br /> 3. The information may be snared with oth��r e scthe permit or <br /> federal. agencies to the extent necessary to p <br /> license. <br /> 4. If your requested permit or license ub qic res Councii. ac��or. <br /> to approve, some information may become p <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> roc�ss this application or <br /> 6 . Your full name is required to p � <br /> permit. <br /> � , ;�1 " cI E�<,����C,) <br /> ��.%G' U <br /> �Argt <br /> idd, e Last <br /> I 7 l/ ��� �:� .���. <br /> Ad ess ,� <br /> �- � <br /> ; � �� � <br /> �� ;; ,v� .s�� <br /> ���t State Z ip <br /> � 1� 7��_ �5�� <br /> Pho, e <br /> , • <br /> I understand ,Pfi rights a s�at�d above. <br /> ���� <br /> Signa re <br /> BUILDING&ZONING—473-7357 <br /> • ADMINISTRATION&FINANCE —�73-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />