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� . <br /> � <br /> �.._' - <br /> - �. <br /> ��` ����" �� (����T� <br /> .� aa. <br /> Post OfSce Box 60•Crystal Bay, Minnesota 5�323•Municipal Qffices <br /> ,;: O1 <br /> � - � �� On the North Shore of Lake 11�finnetonka <br /> DATA PRSVACY 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 wiil be used to determine your <br /> quali�icatien for the per-.nit or I.icense recuested. <br /> 2. You r,tay refuse to supp?y data, but re_usal may require that <br /> the City deny the pe�-mit or license. <br /> 3 . The information may be snared with o�zer ioca? , s�a�e or <br /> federal agencies to the extent necessary to process tne permit or <br /> I.icense. <br /> a. If your requested per.�it or I.icense =ecuires Councii ac�io% <br /> to approve, some infor:nation may become pub�ic. <br /> 5 . You have certain rignts under M.S. 13 .C� to rev�ew griv��e <br /> data on yourself. <br /> 6 . Your fu1Z name is required to process this application or <br /> per:nit. <br /> ) � <br /> �/� � / <br /> �~ '�./�/ .Y�- �P�' � ''�i�-C� ,.�� <br /> Fi rgt Middle ,� Las� <br /> a / <br /> i <br /> /� � � �`-�� , ,�!� <br /> � � , , <br /> Addre <br /> �t/�S A 1 i� _�-�^ ��� , ` `�=' �� <br /> City State Zip <br /> ��� �O r � / �_,-�� <br /> Phone <br /> I und ,tand my rights as stated above. <br /> ;� , <br /> � , <br /> ��-�. '���� . ' �� <br /> i�/'�� �—�. <br /> Signature . � <br /> � ' ' <br /> Bl,'ILDfNG& ZOvI�G - -373-7357 • AD.tii1NISTRAT10Y g FI`+'��`iCE - 473-73=3 • PUBLIC�VORKS -473-73�9 <br /> ASSESS(N G <br />