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� <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal OfSces <br /> � <br /> � - � a 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 wiSl 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 priva�E <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> �D�� �- � �� �a L � _ <br /> First Middl Last <br /> 1��� f-�.n-�r . <br /> Address <br /> t,��c.C-1 Z�c� �-( l� vr��9 � <br /> City State Zip <br /> ��3- �3 �-'7 _ - <br /> Phone � � <br /> I understand my rights as stated above. _ _ _ _ <br /> Sign ure _. � <br /> BUILDiNG dt ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING , , <br />