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CITY of ORONO <br />Post Office Box »i6«Crystai Bay. Minnesota 5oo23 • Mumcipai Offices <br />^otrewK^On the North Shore of Lake \Iinnetonka <br />DATA PRIVACY ADVISORY <br />In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br />data”/ we would like to inforni you that your request for a perniit 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 <br />permit. <br />.his acclication or <br />First <br />Thr^lKdc^ <br />Middle x^ast <br />^11 f^'wrCr'(^f\A)t\J/^Jg'^0( A IfJi‘L. <br />Address <br />fy\ln»^ptrts /Y1^J <br />City State ZlD <br />Phone <br />ilUK,DINC & ZONING - 473-7357 <br />ASSESSING <br />ADMIMSTRA riON Si I IN V.SCf: - 473-7J5.H Fil.ir ’.VOKKS <br />t;*'.