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s-- <br /> � <br /> �i��� O� ����� <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 Iike 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 wil.l be used to determine your <br /> � qualification 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 Iicense. <br /> � 3. The information may be shared with other local, s�ate or <br /> . federal agencies to the extent necessary to process the permit or <br /> license. <br /> ' 4. If your requested permit or Iicense requires Councii ac��or. <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. Yaur full name is required to process this application or <br />� permit. <br /> � <br /> -�,,,, ,� -�1v�P(l� �-�t,n/�- �,.� . �-t i1-�-�►� <br /> First Middle Last <br />' �_��� ���i�.�'l.� �---t /�/(�- i�`�l � <br /> Address <br /> o,�� �/1� �3�2.� _ <br /> City State Z1p <br /> �� 1 � �'i7 �o <br /> Phone <br /> I u er tand my righ a stated above. <br /> Signa re . <br /> BU2LDING&ZONtNG—473-7357 � ADMINISTRATION&FtNANCE—473-7358 • PUBLIC wORKS—473-7359 <br /> ASSESSING <br />