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� <br /> CITY o� O�iONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • _. <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 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.I 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 be shared with other local, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Council. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�at� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ����'°�'`� �- � �t`�--- <br /> First Mid31A Last <br /> � � � �-- l�`��t-- � l.✓� � <br /> Address <br /> ,�����c�2.c,.� 7�u-�.- '6 S 3 ! i <br /> City .. State Zip <br /> - �� s-- ��? - <br /> Phone � <br /> I understand my rights as stated above. <br /> Signatur ' _ <br /> BUILDING&ZO[YING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br /> E <br /> � <br />