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� � ; <br /> � <br /> �'�� `` � <br /> ,�,,,�, �. �. � <br /> , , <br /> ,� � :� <br /> ��%� �°��` �N� �ITY of ORONO <br /> p�„��.�- <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> 0 <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 /> 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 wi3.1 be used to determine your <br /> qualification for the permit or Iicense requested. <br /> 2. You may refuse to supp3.y data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may be shared with other Iocal , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense requires Councii ac��or. <br /> to approve, some information may become publ.ic. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your ful.I name is required to process this application or <br /> permit. <br /> �� `�� sz'� � ��S ��i��� <br /> First Middl Last <br /> � ` <br /> ��� � ��C' <br /> Address <br /> /�C-�'i.�/�� �%�/1� S�-�/�. <br /> City � State Zlp <br /> ��� ���� <br /> Phone <br /> I understand my rights as stated above. <br /> /�� /�; <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSIN G <br />