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CITY of ORONO <br /> ' "�'� z Minnesota 55323•Municipal Offices <br /> 4f177.7,:,:=.0'-'_ Post Office Box 66•Crystal Bay. <br /> QZ� rzka <br /> = -.Q Y On the North Shore of Lake Minnetonka <br /> • <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, <br /> "Rights of subjects of <br /> your "Rireaghtsest for a permit orf <br /> data" , we would like to inform you that ts departments may require <br /> of Orono or any information. <br /> y <br /> license from the certainCiprivate or confidential <br /> you to furnish <br /> You are notified that: - r <br /> you furnish will be used to determine your <br /> 1_ The information eauested• <br /> aualification for the permit or license r <br /> 2. You may refuse to supply data, <br /> but refusal may require that <br /> the City deny the permit or license. <br /> 3. The information may <br /> be shared with other local , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. actor_ <br /> or license reau�res Council 4. If your requested permit ublic_ <br /> to approve, some information may become p <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> rocess this application o <br /> r <br /> 6 . Your full name is required �-�-° p <br /> permit. <br /> fq r 1 i., i. , Last <br /> Middle <br /> First ��- �� �- 5 , v <br /> Address , _ < C <br /> 0 � `�"' State �Zip <br /> City ,\ <br /> Phone <br /> 1 understand my rights as stated above. <br /> t . , , . <br /> ✓l <br /> Signature <br /> • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS—473-7359 <br /> BUILDING&ZONING—473-7357 <br /> ASSESSING <br />