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- � <br /> � <br /> CITY of ORONO <br /> Post O�ce Box 66•Cryatal Bay,Minneaota 55323•Municipal Offic� <br /> • <br /> � - � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would I.ike 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 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 Iocal, s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense 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 /> � L�1�� L�.1k��/�`J - <br /> First � Middle Last <br /> J f��`i� � <br /> Address <br /> � <br /> ����'C' " <br /> � State Zip <br /> ;I.� ,��;h��o�- <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMIIVISTRATION dk FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />