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e _ <br /> ' 0 ' V <br /> ORONO <br /> Municipalof5ces <br /> Post office Box 66 <br /> '`•' ;1- '.: �� �� crystal Bay,Ntitmesota 55323-0066 <br /> L�kES8�4 <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data". we would like to <br /> inform you that your request for a permit or license from the City of Orono or any of its <br /> furnish certain private or confidential information. <br /> departments may require you to <br /> You are notified that: <br /> 1. The information you furnish will be used to determine ;'our qualification for the <br /> permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the <br /> permit or license. <br /> 3. The information may be shared with other local, state or federal agencies to the <br /> extent necessary to process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some <br /> information may become public. <br /> 5. You have certain rights under M.S. 13.04 (see following page) to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> PLEASE PRL\'T <br /> L <br /> First diddle La t <br /> Address <br /> State Zip <br /> City Phone <br /> I understand my rights as stated above. <br /> Signature <br /> TELEPH0A-4 7357. FAX-473.0510 <br />