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CITY of ORONO <br /> _ _ _ <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> OF <br /> oaaNcs On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of <br /> data", we would like to inform you that your request for a permit or <br /> license from the City of <br /> Orono or any of its or confidential departments <br /> rmationmay require <br /> you to furnish certain private <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 /> 3. The information may be shared with other local , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6 . Your full name is required to process this application or <br /> permit. <br /> �QJ� no � <br /> -2c7S .4( <br /> Middle Last <br /> Firstrst <br /> , moi/ d /4c (� ' ��/92 <br /> Address / <br /> /1/ State �P// <br /> City <br /> 23d- 5 <br /> Phone <br /> I unde -•tand my rights as stated a ove. <br /> 4000" <br /> Signature <br /> BUILDING&ZONING—473-7357 <br /> • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />