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ti '�' . <br /> . <br /> �s�' '`x:,�- <br /> ` �� <br /> �'�' ;����� c <br /> � <br /> r �`_' ��Y CITY of ORONO <br /> y ;� <br /> f C <br /> �'.�...._.f�' <br /> � . <br /> Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Offices <br /> • <br /> � - � � On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <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 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 /> qualification for the permit or Iicense 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 CounciZ action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> �� h�irlc�" �✓ ���1 .,Jc,< /�,1�1 _ <br /> Firs Middle Last <br /> C �—" -� �;� <br /> ,� �eC-1 <br /> Address <br /> � � <br /> � ,�%'.�'�1a�; � ��•� �.J.,�>r�C..� - <br /> City State Zip <br /> ���: � �:s� ��L:���- �>> - �3 �y <br /> Phone <br /> n r�stand my rights as stated above. <br /> � ' <br /> �, <br /> � .�, - ,��- <br /> ,_ � �--�-�i� � ,� l � <br /> , � <br /> _�. u e . <br /> BUILDING&ZONING—473-7357 • ADMINISTRAT[OIV&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />