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„. , <br /> c : <br /> .,_._. _ \ <br /> ,(\.. <br /> , . CITY of ORONO <br /> -- Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> OF <br /> ctRaNcr 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 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 /> 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 /> Z_AQ P`f-ii r O&_c21 1 I-CiowS r Grp. <br /> First Middle Last <br /> 7 GI dol 1---AWryi0A. �ii,_ <br /> Address <br /> 1/1 ((,/1 Gro, Ah w 55361 <br /> City State Zip <br /> Zp- i cab(, <br /> Phone <br /> I under - d my rights as stated above. <br /> n <br /> /4 <br /> 4kjvt/ bivG_e_lll At col c ? r�5 . <br /> Si• -ture <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />