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10/18/94 16:26 THE CITY IF ORON0 612-473-7357 003 <br /> CITY of ORON4 <br /> Post VISce Box 66•CrYetei Say,Minamota 5SS230MuOieibsl Oflic'm <br /> OF <br /> . � • • On the North Shore of Lake Minnetonka <br /> DATA PgZYACY ADVISORY <br /> In accordance with M.S. 13•ou,thatdyour request totsubjects <br /> s permit or <br /> data^. we would like to inform y require <br /> license furnish <br /> the <br /> tail p Orono or any of its departments private or confidential information.�ay <br /> you to furn>.s <br /> You are notified that: <br /> 1. The information you furnish will be uuest a•determine your <br /> qualification for the permit or license req <br /> 2. you may refuse to supply data, but refusal may require that <br /> the City deny the permit or license. <br /> p state or <br /> 3. The information may be shared with pr,ocesshercalthe permit or <br /> federal agencies to the extent necessary <br /> license. <br /> 4. If your requested permit or license <br /> 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 /> g, your full name is required to process this application or <br /> permit. <br /> 14 <br /> / Last <br /> First Middle <br /> Address <br /> C <br /> I State Zip <br /> Cit <br /> `556- <br /> Phone <br /> I understand my rights as stated above, <br /> 431ature <br /> i <br /> BUILDING&ZONING—A73.7357 • ADMINISTRATION&FINANCE— <br /> 473-7358 • PUBLIC WORKS—473-73S9 <br /> ASSMING <br />