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CITY ©f ®ROOT® <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> M - <br /> On the North Shore of Lake Minnetonka _ <br /> DATA PRIVACY ADVISORY <br /> Subd. 2, "Rights of subjects of <br /> 13.04, permit or <br /> in accordance with M.S• You that your request for a P wire <br /> data", we would like to inform Y of its departments may req <br /> license from the City of Orono or any <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The information you furn <br /> qualification for the pemit Or <br /> license brequested determine your <br /> , require that <br /> 2. You may refuse to supply data, but refusal may <br /> the City deny the permit or license. <br /> be shared with other local , state or <br /> 3. The information may process the permit or <br /> federal agencies to the extent necessary to p <br /> license. <br /> a If your requested permit or lerequ1res Council act-ion <br /> oI: <br /> to approve, some information may become public. <br /> S. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> uired to process this application or <br /> 6. Your full name is req <br /> permit. <br /> ^cc rr n <br /> IYi�+Ae` +jiLast <br /> Middle <br /> First <br /> 37 <br /> /Address <br /> w State, Zip <br /> C1tr,L Warms <br /> 11710 0z 3 Sas �8ad_ <br /> phone <br /> I understand my rights as stated above. <br /> S ' natur <br /> • PUBLIC WORKS—473-7359 <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> ASSESSING <br />