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� <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 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 /> 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 /> 1. The information you furnish wil.l 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 /> Zicense. <br /> 4. If your requested permit or license requires Council action <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 /> r� �r�c� <br /> First Middle Las <br /> ��� �f�s.�- �-�- <br /> Address <br /> ��e� s<<e� � � �J <br /> City State Zip <br /> `7 -/ � `��� _ <br /> Phone— <br /> I understand my ri hts a tated above. <br /> . � <br /> Signature . <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION 9c FINANCE—473-7358 • PUBLIC WORKS—473-7359 , <br /> ASSESSING <br /> ! <br />