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A „ <br />i . <br />CITY of ORONO <br />Post Office Bo: 66•Crystal Bar, Minnesota W23•Munieipal Offices <br />On the North Shore o/ Lake Minnetonka <br />DATA PRIVACY ADVISORY <br />In accordance with M.S. 15.165, "Rights of subjects of data", <br />we would like to inform you that your request for a permit or <br />license from the City of Orono or any of its departments may <br />require you to furnish certain private or confidential inform- <br />ation_ <br />You are notified that: <br />1. The information you furnish will be used to determine <br />your qualification for the permit or license requested. <br />2. You may refuse to supply data, but refusal may require <br />that the City deny the permit or license. <br />3. The information may be shared with other local, state <br />or federal agencies to the extent necessary to process <br />the permit or license. <br />4. If your requested permit or license recuires Council <br />action to approve, some information may become public. <br />5. You have tertian rights under M.S. 15.165 to review <br />private data on yourself <br />6. Your full name, and date of birth are required to process <br />this application or permit. <br />irst Ki a a Fe— <br />f c . j c <br />A ress <br />i- <br />Cate'of birth oes not apply to building/general permits <br />�1;cr.e <br />.ry r:chts as state.' above. <br />r l <br />J: ;F.5tuic <br />s� a nt.(. a 14 •���. i t �y 0 a0%1%ISTit afUf%a 11%4..%(1 - 47)'I38 0 M at 14 M4IRK % • ; <br />