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I � � <br />� <br />�� <br /> ' - � C��`�' o� ���I\TO <br /> M� <br /> Post Office Box 66`CrYstal Bay.Min�esota 5a323•Municipal Offices <br /> � - <br /> On the North Shore of Lake Minneton a <br /> • ' � • <br /> DATA PRSVACY AD�SORY <br /> Subd. 2, "Rights of subjects of <br /> 2n accordance with M.S. 13•ou�that your request for a perm ui�e <br /> data", we would like to inform y o f its departments may req <br /> license from the City o� Orono or any <br /> you to furnish certain private or confidential insormation. <br /> You are notified that: <br /> �, The in�ormation you furnish will be used to determine your <br /> cualif-cation for the pe�i� or license requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> tne City deny the permit or license. <br /> be snared w�th other Iocal , s�ate or <br /> 3. The information may rocess the permit or <br /> federa� agencies to the extent necessary to p <br /> license. . � <br /> your reauested Pe�=-t <br /> or iice*�se -eQuirPs Cou�cli ac��o% <br /> �. Li L become public. <br /> to aporove, some in=orma�ion may � <br /> J • <br /> You have certain rights under M.S. 13.Oa to review pr�.va..e <br /> data on yourselr. y , <br /> � �ss th�s 3DD1-�ca �-'-on or <br /> 6 . Your full name is required �.o proc_ <br /> pe�it. <br /> �_ �� �� ��� ���C�� �� <br /> ' � �`i�� � �^S�� ,� Las� <br /> ` Midd?e <br /> r irs�. , �� <br /> ` :� -�t S �. <br /> � �Z � U' �i ��t f�" �'1 � ' <br /> �,�cress -� <br /> �G-� ��� �7'1/`� � � �:S��-. <br /> � zip <br /> State <br /> City . <br /> ���� 5��- 3 `� � r�� <br /> Phone <br /> I understand my rights as stated above. <br />� _----� . <br />. _- ___ - <br />;� . <br />� . ./l.. / , <br /> ign � <br /> BUILDING&ZONING—473-�357 + ADMINtSTRATtON&FINANCE—473-7358 <br /> • PUBLIC WORKS —473-7359 • <br /> ASSESSIN G <br />