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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, ·"Rights of subjects of data", 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. <br />2. <br />4. <br />5. <br />The information you furnish will be used to determine your qualification <br />for the permit or license requested. <br />You may refuse to supply data, but refusal may require that the City deny <br />the permit or license. <br />The information may be shared with other local, state or federal agencies <br />to the extent necessary to process the permit ?r license. <br />If your requested permit or license requires Council action to approve, <br />some information may become public. <br />You have certain rights under M.S. 13.04 (see following page) to review <br />private data on yourself. <br />6.~ Your full name is required to process this application or permit. <br />-VJCJ.v\1= _s:-{)/so~ <br />Middle Last <br />/2~ O/¥(Jv {!fl/JS£ J)l2 <br />Address <br />Zip <br />I u~-bo_v_e_. ___ _ <br />Signature <br />TELEPHONE -4717ss1 • EU-473--0510