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CITY of ORONO <br />Municipal Offices <br />Post Office Box 66 <br />CrystalBa~Minnesom55323-0066 <br />DATA PRIVACY ADVISORY <br />In accordance with M.S. 15.165, "Rights of subjects of data", we <br />would like to inform you that your zoning request with the City of <br />Orono or any of its departments may require you to furnish certain <br />private or confidential information. <br />You are notified that: <br />1. The information you furnish will be used to determine your <br />qualifications for approval. <br />2. You may refuse to supply data, but refusal may require that <br />the City deny the request. <br />3. The information may be shared with other local, state or <br />federal agencies to the extent necessary to process the <br />request. <br />4. If your request requires Council action to approve, some <br />information may become public. <br />5. You have certain rights under M.S. 15.165 to review private <br />data on yourself. <br />6. Your full name is required to process this application. <br />' /)131);0 {}/}BU Q ;J <br />First Last <br />Address <br />City State Zip <br />H S'l/-1-/b.!:)tJ ---w. -9.3~ ¥cfs3 <br />Phone <br />I understand my rights as stated above. <br />~ Signature <br />TELEPHO~E-473-7357 • FAX-473-0510