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. ,. <br /> � <br /> C ITY of ORONO <br /> Post Office Box 66•Cryatal Bay,Minneaota 55323•Mnnicipal Offices <br /> • <br /> � � � � 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 like 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 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 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 Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review privat� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> 0 <br /> First M' dle Last <br /> �Z�C� �O � �- � <br /> Address <br /> �o� Iv1� �S3S� <br /> Cit State Zip <br /> ��5-C�L2__- <br /> Phone <br /> I understand my rights as stated above. <br /> Si nature <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING = <br />