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r n M <br /> I <br /> CITY of ORONO' <br /> Post Office Box 66•CrystaI Bay,Minnesota 55323•Municipal Offices <br /> o o o 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 /> data" , we would like 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 informationohey° be used to requested, determine your <br /> qualification f Permit or license <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 <br /> to the extentshared <br /> necessarywith <br /> local, <br /> to processthe permit or <br /> federal agencies <br /> license. <br /> 4. If your requested permit or license 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 /> N e t `1" Last <br /> First Middle <br /> Address <br /> L <br /> City State Zip <br /> tl7a) <br /> Phone <br /> I understand my rights as stated above. <br /> • 2 a �c �W cSSes <br /> CS1a <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 PUBLIC WORKS —473-7359 <br /> • <br /> ASSESSING <br />