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. <br /> . <br /> � <br /> CITY of ORONU <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � _ � � On the North Shore of Lake Minn.etonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would 3ike 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 wi31 be used to determine your <br /> qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusa3 may require that <br /> the City deny the permit or license. <br /> 3. The information may be shared with other local , s�ate 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 act�or. <br /> to approve, some information may become pub3ic. <br /> 5. You have certain rights under M.S. 13.09 to review private <br /> data on yourself. <br /> 6. Your full name is required �o process this application or <br /> pe�mit. <br /> s (�CJ �+� �/'� ��J <br /> First . •- Middle Last <br /> 1 g v2 �i��D�,�� �2• - . <br /> Address <br /> I�Uc�o.�� �� � �1�-� �s�a- --�� <br /> City State Zip <br /> ���- �3 �- 3� s� <br /> Phone <br /> I unde stand my rights as stated above. <br /> ,ZY/`��A--ri6� ��sv� <br /> �G�7� �GrJ�, <br /> � S ' ture <br /> BUILDING&ZONING—473-7357 � ADMINISTRATION&FIN.�.NCE—473-7358 • PUBLiC WORKS—473-7359 <br /> ASSESSIN G <br /> � <br />