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. <br /> 12i22�94 16:27 THE CITY OF ORONO 612-473-?357 003 <br /> � <br /> GITX of aRONU <br /> Yost Office Box 66•Crystal Bay,Minn�eota 5b.3?3�Manicipsl Ol�em <br /> • <br /> � � � � On the North Shose of Lake Mittnetonka <br /> DATA PRIVACY ADVISORY <br /> Sn accordance with M.S. 13.04. Subd. 2� "Rights of subjeets of <br /> data",. we would 3.�.ke to inform you that you� request for a permit or <br /> lf.cense from the City of Orono or any of its departments may require <br /> you to furnish certain private or conf�dential information. <br /> You are notified that: <br /> 1. The information you furni.sh will be usec3 to determine your <br /> qualification for the permit or licen$e requested. <br /> 2. Yau max zefuse to supply data, but z'efusal may require that <br /> the City deny the permit or 3icen�e. <br /> 3. The �nformation may be shared with oth�r �.ocal, s�ate or <br /> feaer�l ag�ncies to the extent necegsary to process the permit ox <br /> license. <br /> 4. I� your requested pez'�nit or Iicense requires Councii ae��on <br /> to approve, some inform�tion may become public. <br /> 5. You have certain rights under M.S. 13.04 to r�v=ew private <br /> d�ta on yourself. <br /> 6. You= full name is zequired to process this applicatien or <br /> permit. <br /> James N. Jensen <br /> First Middle Last <br /> 601 Lakeshore Pkwy #1225 <br /> Address <br /> Minnetonka, MN 5 <br /> City State �1P <br /> 612-475-0548 <br /> Phone <br /> I understand my rights as statec] above. <br /> S gnature , � <br /> BUILDING�ZONING^473-735� • ADMWIS7'RATIOIY lt FINANCE—s73•7358 � PUDLIC WORKS—4'73-7359 <br /> ASSESSING <br />