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I -• � <br /> � <br /> . � <br /> C ITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal 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 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 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 �ocal, 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 Counci3. action <br /> to approve, some information may become public. <br /> 5. You have certain rights �nder M.S. 13.04 to review pri�at� <br /> data on yourself. <br /> 6. Yaur full name is required to process this application o� <br /> permit. - <br /> t�layn�� C��-n�ES �vlC��+�N��u <br /> First Middle Last <br /> 36.5�3 ���i��� �"� �-� . - <br /> Address <br /> 4� - ���S �t� � � �S�fil � <br /> City State Zip <br /> qZ��S �� <br /> Phone <br /> I understand my rights as stated above. <br /> C► <br /> � <br /> Signatur <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />