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T <br /> CITY ©f ORONO <br /> M <br /> post Office Box 66•Crystal Bay.Minnesota 55323•Municipal Offices <br /> On the North Shore of Lake Minnetonka <br /> DATA pRSVACy ADVISORY <br /> Subd. 2, "Rights of subjects <br /> t or <br /> In accordance with M.S. 13•ou,that your request for a P <br /> data" , we would like to inform y of its departments may require <br /> Of Orono or any - reformation. <br /> license from the City Private or confidential <br /> you to furnish cer�ain p <br /> you are notified that: <br /> The information you furnishi enseill brequeste used eddetermine your <br /> _ <br /> qualification for the peri t or 1 <br /> 2_ You may refuse to supply <br /> data, but refusal may require that <br /> the erlllit or license. <br /> the City deny P <br /> shared with local , state or <br /> ith o <br /> 3 _ The information may be rpCess the permit or <br /> federal agencies to the extent necessary to p <br /> license. action <br /> license requy-r-s Counc4i <br /> a, _f your requested Permit or ub1; c. <br /> to approve, some <br /> in-Format_on may become p <br /> You have certain rights under M.S. 13. 04 to review Private <br /> data on yourself. <br /> Your full name is requi red to process this application or <br /> 6 . <br /> permit. <br /> ` S cR� <br /> P' Las-c� <br /> Middle <br /> First <br /> C-' L <br /> c,ddres s <br /> o uIL Af Zip <br /> State <br /> City <br /> 07 � V <br /> Phone <br /> I understand my rights as stated above. <br /> r�r - <br /> Signature <br /> —173 7358 <br /> • PUBLIC WORKS—473-7359 <br /> ADMINISTRATION&FINANCE <br /> BUILDING&ZONING—473-7357 <br /> ASSESSING <br />