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10/18/94 16:26 THE CITY OF ORONO 612-473-7357 003 <br /> CITY of ORONO <br /> Post Vlltce[fox 68•Csyevl Say,Minnesota 55323•Municibsl offices <br /> CITY' <br /> OF <br /> On the North Shore of Lake Minnetonka <br /> • • • • <br /> DATA PRIVACY AxtzSoRY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> you that your request for a permit or <br /> data", We would like to inform y require <br /> license from the certain private or coof Orono Or nfidential f its; information. <br /> you to furnish <br /> You are notified that: <br /> 1, The information You <br /> ar license e used to requested.determine your <br /> requested, <br /> qualification for the <br /> P <br /> 2. You may refuse to supply <br /> data, but refusal may require that <br /> the City deny the permit or license. ther <br /> alp state or <br /> 3. The information may to nt necessary shared withto process othe permit or <br /> federal agencies to the exte <br /> license. license <br /> may <br /> 4. If your requested permit m <br /> or become public. esCouncil action <br /> to approve, some information <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 /> Ii` // <br /> Mid le Last <br /> First <br /> qv a� �U) <br /> Address / e12--StLaW <br /> ,City `�/,� Zip <br /> phone /✓v <br /> I understand my rights as stated above. <br /> Sig ature <br /> BUILDING&ZONING-A73.1357 • ADMINISTRATION&FINANCE-473-7158 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />