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S <br /> CITY of ORONO <br /> - __"-= Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> Q On the North Shore of Lake Minnetonka <br /> DATA PRSVAC'Y ADPTSORY <br /> Subd. 2, "Rights of subjects of <br /> In accordance with M.S. 13.04 , 1 our request for a permit or <br /> data", we would like to inform you that y <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 information you furnish will be used to determine your <br /> qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or license. <br /> be shared with other local , state or <br /> 3 . The information may process rocess the permit or <br /> federal agencies to the extent necessary <br /> license. <br /> 4. If your requested permit or license requires Council action <br /> nformation may become public. <br /> to approve, some i <br /> You have certain rights under M.S. 13.04 to review private <br /> 5. <br /> data on yourself. <br /> 6 . Your full name is required to process this application or <br /> permit. <br /> CJu2._. 4 S, , / 0,-'--eA—_ <br /> a. • •., S Middle Last <br /> First L lk <br /> Address �5� <br /> - {' Zip <br /> City <br /> ____LI:IL.12________ <br /> State <br /> Phone • <br /> I understand my rights as stated above. <br /> Signat $ <br /> 'WILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />