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� .:��• <br /> ,,� , � <br /> fi�t <br /> ���� <br /> �- � }_� CITY of ORONO <br /> � <br /> .,������s4 <br /> � � � F Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> ,;, <br /> �� � <br /> � . �a�'� <; 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 Iike 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 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 reguire 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 grocess the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Counci� action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 �o review privat� <br /> data on yourself. <br /> 6. Yc,ur full name is required to process this applicatian or <br /> permit. <br /> �,�di�✓%L/� <br /> � � `�Yf� r/� lG��. <br /> First Middle Last <br /> f � C / N� /i✓NG//��/.� .��� ��� - <br /> Address <br /> �i �i9�e'z %yi�- .�SiGG <br /> City State Zip <br /> �� �� � �'�S i <br /> Phone <br /> I understand my rights as stated above. <br /> C , �� � '� � . <br /> Signat <br /> BUILD[NG&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />