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,� <br /> • <br /> ����^�' � <br /> � �, ��..�� <br /> �r.�a� �4a:�.�. :-� <br /> � , ,.. <br /> Ra <br /> :4 .�.'�,H<..r <br /> -�� � �i��� O� �R�N� <br /> .���,+f��.;�r,,�...�..ts�.��#'��?'.��� <br /> ky'T4XE.�:`I"^�'I.�k'_'3^"�E+IC.4p� <br /> S�34J�>. V �,.y4tt�-�s�l <br /> ' ,..,, Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> ;�;�;����;u��^� <br /> �R .�r�°�;:. <br /> � <br /> ��+- . <br /> � ' - a � � �' On tlze North Sicore 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 Iike to inform you that your request for a permit or <br /> license f rom 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 Iicense. <br /> 3. The information may be shared with other Iocal , state or <br /> federal agencies to the extent necessary to process the permit ar <br /> Iicense. <br /> 4. If your requested permit or Iicense requires Council act�or. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit� <br /> � ��� ��� ������2 <br /> � �� � <br /> First Middle Last . <br /> � 3 t� �`�' s n �r /il, <br /> Address <br /> l/�l�/r ����� �S.3S� <br /> City State Zip <br /> ��� � ���� <br /> Phone <br /> I unde and my, rights as stated above. <br /> // <br /> •�) � <br /> / C <br /> a ur � <br /> �- <br /> BUILD[NG&ZON[NG—473-7357 • ADMINISTRATIOIV&.FINANCE —473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />