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� <br /> �z.;;�. <br /> ;..' �. <br /> ' ��f � ',�«; .;�� <br /> `� �":i _;4F <br /> , r t ; k <br /> j t ` �` `' C ITY of URONO <br /> �' �rz <br /> �'} �4�;�i� f . {� <br /> F ��'� '��� ° � ; Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> � � � ' t � <br /> ���' `'` On the North Shore of Lake Minnetonka <br /> ,::� 3.,�,�.:: <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 /> l. The information you furnish will be used to determine your <br /> qual�.fication 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 ar license. <br /> 3. The information may be shared with other �oca� , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested oermit or Iicense requires Councii. action <br /> to approve, some information may become pubiic. <br /> 5. You have certain rights ander M.S. 13.04 �o review priva�� <br /> data on yourself. <br /> 6 . Y�ur full name is required to process this a�r.lica�icn or <br /> permit. <br /> � -�����(� <br /> ,-, <br /> �irst Middle Last <br /> �=��7 /����1 �/ D �7� �C(/�- - <br /> Address , <br /> �����l�� ,����! , <br /> City State Zip <br /> ���-�-7 �� <br /> Phone <br /> I un tand my rights a st ed above. <br /> � <br /> f ���/��--�� <br /> ature - <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FI�IANCE —473-7358 • PUBL[C WORKS —473-7359 <br /> ASSESSING <br />