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CITY OF ORONO ii 6124730510 09/12/96 07:20 i5l :11/16 N0:321 <br />i <br />'~ <br />1 J <br />CITY of ORONO <br />Municipal Offices <br />Street Addl'III! Mallln1 AddraU: <br />P.O. Soi 66 2750 ~!lay Partway <br />Orone. MN 5S356 Cl)stal Bay, MN 55323-0066 <br />DAIA fBJVACY ADVTSOR"( <br />In accordance with M.S. 13.04, Subd. 2, "Rights of subjects ,,f 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 />l. The information. you furnish will be used to determine your qualificafa,n for the <br />permit or license requested. <br />2. You may refuse to supply data, but refusal may require that the City deny the permit <br />or license. <br />3; The information may be shared with other local, state or federal agencies to the <br />extcmt 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 data <br />on yourself. <br />6. Your full name is required to process this application or permit. <br />James N. Jones <br />First Middle Last <br />.. 601 Lakeshore Parkway #1225 <br />Address <br />Minnetonka <br />City <br />MN 55305 475-0548 <br />State Zip Phone <br />Telepbosae (6U) 47J..7357 • FAX 473-0510 <br />10