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` f�,#�`_"�f'd t �.II_` <br /> �p`n < ..'Y r'�S1 e.. A. <br /> � . � d � i.�i' <br /> r :,r �� r <br /> ����R� CITY of ORONO <br /> , � .. <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <br /> � - o � 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 /> Iicense 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 wi3.1 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 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 license requires Councii 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 �o process this application or <br /> pe!�mit. <br /> . , . ,' , �, _ <br /> ,�; <br /> First Middle Last <br /> - ' .� ,/����-- f..: <br /> Address <br /> � ��- � - ;��=1 fJ,% , , - <br /> City State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> i �, ,, <br /> ' ��y y�,._ <br /> C_ . � . <br /> Signatur� <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />