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» • f <br />!ti <br />VIMW r 'V! <br />CITY of ORONO <br />Post Office Fiox 66*Crystal Bay, Minnesota 5532.'1«Municipal Offices <br />On the North Shore of Lake Minnetonka <br />DATA PRIVACY APVljSORY <br />In accordance with M.S. 15.165, "Rights of subjects of data", we <br />would like to inform you that your request for a permit or license <br />from the City of Orono or any of its departments may require you to <br />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. 15.165 to review private <br />data on yourself. <br />6. Your full name, and date of birth are required to process <br />this application or permit. <br />(I \i'.V- D' it'-AJ <br />First <br />0y> <br />Middle <br />Address <br />City ' <br />lUo <br />state <br />... <br />Zip <br />Phone <br />I understand my ^ghts as stated above. <br />n <br />sT^hature <br />BUILDING A ZONING - 473 7357 • <br />ASSESSING <br />a DMIMSTR a TION a finance - 473 7358 PUBLIC WORKS - 473*7359