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- -: CITY of ORONO <br /> - Post Office Box 66•Crystal Bay,Minnesota 53323•Municipal Offices <br /> OF <br /> ORONO 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 /> or confidential departments <br /> may require <br /> you to furnish certain private <br /> You are notified that: <br /> 1. The information otheypermit or licensebe used to requested. determine your <br /> qualification <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 /> c/L. k_SS-"4 <br /> First <br /> Middle Last <br /> D 9 <br /> F,Wf(6,4 A's <br /> Address <br /> 0/i(.5 ,4Q C 44/1 S Y/Z- <br /> City State Zip <br /> 4/Z) q2> ey /4 <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />