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CITY of ORONO <br />Post Office Box 66 • Crystal Bay, Minnesota 55323 • Municipal Offices <br />On the North Shore of 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. <br />2 • <br />3 . <br />4. <br />The information you furnish will be used to determine <br />your qualification for the permit or license requested. <br />You may refuse to supply data, but refusal may require <br />that the City deny the permit or license. <br />The information may be shared with other local, state <br />or federal agencies to the ex~ent necessary to process <br />the permit or license. <br />If vour reauested permit or license requires Council <br />actlon to ~pprove,-some information may become public. <br />5. You have certian rights und~r M.S. 1s:16S 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 />Fred <br />First Middle <br />Rruntjen <br />Last <br />Address <br />Ex celsior MN 55331 <br />Date of birth (does not apply to building/general permits) <br />Phone <br />I <br />BUILDING & ZONING -473-7357 <br />ASSESSING <br />ADMINISTRATION & FINANCE -473-7358 • PUBLIC WORKS -473-7359