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�-..,. � <br /> ;,�, r^,��` <br /> ���3.�� CITY of ORONO <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <br /> � _ � � 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 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 will 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 license. <br /> 3. The information may be shared with other Iocal , state or <br /> federal agencies to the extent necessary to �,rocess the permit or <br /> license. <br /> 4. If your requested permit or license requires Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 �o review pri�a�� <br /> data on yourself. <br /> 6. Yaur ful.I name is required to process this apglicaticn or <br /> permit. <br /> �, , I :�.:,., �..__��� <br /> Fi st � Middle Last �q,/�1� <br /> .- ��K� <br /> �i�S � ��.,C�.«�, , �` t L�a�v�sc.a�.r�� <br /> Address � c�. (3c'x 5-a�S <br /> ��. �.c�.,..�-�. �`�11.� S S �y � ��,�,1 k�� /`1�� �s�"� <br /> City State Zip <br /> � �3� �C1 �S �S �O -a�y � <br /> Phone <br /> I unders nd my rights s stated above.� <br /> � ��. <br /> �-- � � `l �� <br /> S ' tur <br /> � <br /> _---�-�=--_-_. . <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&F1tiANCE —473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />