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� <br /> ` 'Y'Y Of ORONO <br /> CI <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offsces <br /> • <br /> � . � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY 1�DVISORY <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 o r�ate or confidential e nfo ationmay require <br /> you to furnish certain p <br /> You are notified that: <br /> 1. The informa�ti�heY°e�itnor Iicensebreque ted. determine your <br /> qualification f P <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 ��rocessCthe permit or <br /> federal agencies to the extent necessary to p <br /> license. <br /> 4. If your reque f�at on may be ome pubii�ires Council action <br /> to approve, some i <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Yaur full name is required to process this applicatian o� <br /> permit. <br /> � qT � <br /> • ��►1� <br /> First Middle Last <br /> � �� �.� � � <br /> Address <br /> '�l I�� S� (( J <br /> City State Zip <br /> ? � 3�3 �� 3 <br /> P:�one <br /> I understan ' g t as stated above. <br /> Signature <br /> BUILDING&ZONiNG—473-7357 � ADMINISTRATION�FINAIVCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />