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� _ o <br /> C ITY of ORON <br /> Post Office Box 66•Crystal Bay,Mianesota 55323•Municipal Offices <br /> . � <br /> � _ v a. 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 Pereq ire <br /> license from the City of Orono or any of its departments may <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> 1. 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 permit or license. <br /> 3. The information may b ent neces aryhto processcthe pe it or <br /> federal agencies to the ext <br /> license. <br /> 4. If your requested permit or license requires Counci3 action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�e <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> G� � �J 4` X <br /> First <br /> Middle Last <br /> — � <br /> A dress � <br /> � �– <br /> 6 <br /> ity State Zip <br /> Pho e � <br /> I understand my rights as stated above. <br /> S ature � - <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION�FINANCE—473-7358 <br /> • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />