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- <br />CITY of ORONO <br />Municipal Offices <br />Post Office Box 66 <br />Crystal Bay, Minnesota 55323-0066 <br />DATA PRIVACY ADVISORY <br />In accordance with M . S . 13. 04 , Subd. 2, 11 Rights of subjects of data 11 <br />, we would like to <br />inform 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 information. <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 license. <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. If your requested permit or license requires Council action to approve, some <br />information may become public. <br />5 . You have certain rights under M .S . 13 .04 (see following page) to review private <br />data on yourself. <br />6. Your full name is required to process this application or permit. <br />First Middle <br />f!:>,A y 5 ({)£ <br />Address <br />111;1./ <br />City State <br />I understand my rights as stated above . <br />Signature <br />TELEPHONE-483-7357 • FAX-4~10 <br />Last <br />q-3_s-7 <br />Zip <br />'13/ 7 -007) <br />Phone