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. _., . . <br /> ,..2 ___- _-- _,- .:,.- <br /> -• (JITYofORONO <br /> il, _ CI-M_-,-,-.:- Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> Q 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 /> or <br /> data", we would like to inform you that your request for a permit <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 heye permit 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 he permit or <br /> federal agencies to the extent necessary to process <br /> r <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 /> i itz19 A- 6e-a if- Q___ Sfr.--- 1.-- —2_ <br /> Last <br /> Fir t M dle <br /> 7 ?O 6")/ <br /> 7 <br /> Address 5-5-13 3 j <br /> City State Zip <br /> Phone <br /> I and iand my light- as st- = •ove. <br /> tomi <br /> ISI <br /> Sign=ture / <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />