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. t� - . • <br /> . � s�; <br /> �� �.,��' '� ' �� !=� <br /> � � � `�� C ITY of ORONO <br /> � ; <br /> '' •�^� { Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> - t� _� <br /> � ��9 y <br /> k�""" � On the North Shore of Lake Minnetonka <br /> • � e � <br /> DATA PRNACY AD�TISORY <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 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 I.icense. <br /> 3. The information may be shared with other iocal , state 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. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 �o review priva�� <br /> data on yourself. <br /> E. Y�,ur full name is required to process this applica�ian or <br /> permit. <br /> �(.��1.�i�� �i J\Q(r"C�� ��� 'r�/�_ <br /> First Middle Last � tl <br /> �����i' �/rL',� b�y rrC� <br /> Address <br /> ' �y�`"�� y <br /> ,�i'//G c:1 ,�// ''� <br /> City State Zlp <br /> 1/7�� - �it� S_' <br /> Phone <br /> I understand my rights as stated above. <br /> � // <br /> �� <br /> ignature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATIOIY&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />