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CITY ©f ®BODY® <br /> M <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> On the North Shore of Lake Minnetonka - <br /> DATA PR=pACY ADVISORY <br /> Subd. 2, "Rights of subjects of <br /> 13.04 , gest for a permit or <br /> In accordance with M-S• you that your req 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 /> The information you furnish will beeQuested..sed to Qetermine your <br /> 1• e,-mit or license <br /> aualification for the p uire that <br /> refuse to supply data, but refusal may req <br /> 2. You may <br /> the City deny the permit or license.be shareor <br /> d with other Local , state <br /> 3• The information may rocess the permit or <br /> federal agencies to the extent necessary to p <br /> license. <br /> iice_;se requires Council ac�-or. <br /> e. If your recuested pe-=it °r ublic. <br /> to approve, some information may become p <br /> M.S. 13.04 to review private <br /> C . You have certain rights under <br /> J <br /> data on yourself. • On or <br /> 6 . Your full name is required to process -L -114s appl=-cam- <br /> pewit. <br /> ,� • � Last � <br /> Middle <br /> First <br /> Address <br /> v State Zip <br /> City <br /> Phone <br /> I understand my rights as stated above. <br /> SI natitre <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473 7358 <br /> • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />