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•t- <br />'A ^ <br />•y- - <br />CITY^OBONO <br />anrvF— <br />&■ <br />OE= <br />ammEt <br />Post Uffic*? Box 'V5»OrysLai Bay <br />On the North Shore of Lake Minnetonka <br />tonr55323 • Mumcipai Offices <br />DATA PRrTACY ADVISORY <br />MAR 1 9 <br />'•N In accondanc© with M.S. 13.04/ Subd. 2/ "Richts of subjects or <br />data**, we would like to inform you that your request for a permit or <br />license from the City of Orono or any of its depa^rtments 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/ out refusax may require tha <br />the City deny the permit or license. <br />3. The. information may be shared with other local, state <br />federal agencies to the extent necessary to process the permit or <br />license. <br />4, If your requested permit or license requires Councix action <br />to approve, some information may become public. <br />5. You have certain righrs under M.S. 13.04 to review private <br />data on yourself. <br />6. Your full name is required to process this applicadlidft^i^'ii- <br />permit. <br />rTTv /ic r/or.Aip <br />uyAf.s"L f'lCr Trc <br />i- U# » 4U1- <br />ruurk’C ML.UM <br />n? rCA/ <br />V 4. A. IT <br />TiI I. <br />CTrT <br />50. <br />* OAi Tf7 <br />i ItV'A ' XiJ <br />First Middle Last <br />* T / f O <br />VW*/ X / f <br />9co Fn-<rr <br />Address <br />A .'A <br />:p s-J-9 / <br />City <br />■y7A- ^^7,1 <br />State Zio <br />Phone <br />I understand my rights as stated above. <br />A/cAuesr C/yOc’C- <br />-------------------------------------------------------- <br />Si^ature <br />BUILDING a ZONING - 473-7 35 <br />assessing <br />administration a finance - 473-7 35 R PUBLIC WORKS - 473-7 359 <br />r- u