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r or\vV •. <br />H fM CITY of ORONO <br />Municipal Offices <br />l$SH$ <br />Street Addrets: <br />2750 Kelley Parkway <br />Orano, MN 55356 <br />Maillni Address: <br />P.O. Box 66 <br />Ciystal Bay, MN 55323-0066 <br />, data priva cy advisorv <br />In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to <br />mfonn you that your request for a permit or license from the City of Orono or any of its <br />departments may require you to furnish certain private or confidential infonnation. <br />You are notified that: <br />1. The information you furnish will be used to determine your qualification for the <br />permit or license requested. <br />2.You may refuse to supply data, but refusal may require that the City deny the <br />permit or kcense. ' ^ <br />3.The information may be shared with other local, state or federal agencies to the <br />extent necessary to process the permit or license. <br />4.your requested permit or license requirci Council action to approve, some <br />information may become public. <br />5.You have cenain rights under M.S. 13.04 (see following page) to review private <br />data on yourself. <br />6. <br />First <br />Your full name is required to process this application or permit. <br />Middle ' Last <br />Ct- <br />5 (0 <br />Phone <br />I mjiefefand my 6d my ^ts as stated abo^ e. <br />Signature <br />Tdcphooc (952) 249-4600 • Fax (552) 249-4616 <br />wwi»xl.oronojan.ui