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10/18/94 16:26 THE CITY OF ORONO 612-473-7357 003 <br /> M <br /> CITY of ORONO <br /> CITY Post Ot19ce Box BB•Crystal Bsy,Minnesota 51323•Manici0sl Offices <br /> OF <br /> R • <br /> 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 /> m <br /> data", we would like to inforyou that your request for a permit or <br /> f its license from the City Of ive or coor n ideritial departments require <br /> nformation- <br /> you to furnish certain pan <br /> You are notified that: <br /> 1. The informationYou -fu or license 111 be used to determine your <br /> qualification for the <br /> permit <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 local , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> ed oration mor ay become license <br /> res Council action <br /> 4. If your request <br /> to approve, some infor <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 /> / Last <br /> First Mid le <br /> Address <br /> N zip <br /> City State <br /> Phone <br /> I understand my rights as stated above. <br /> Sgnatiure <br /> BUILDING A ZONING-473.1357 • ADMINISTRATION A FINANCE-473-7356 • PUBLIC WORKS-473-7339 <br /> ASSESSING <br />