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.. ·~·. ;/0 0 ., <br />: . ., <br />Municipal Offices <br />Post Office Box 66 <br />Crystal Bay, :\linnesota 55323--0066 <br />DATA PRIVACY ADVISORY <br />In accordance wirh M.S. 13 .04, Subd. 2, "Rights of subjects of data", we would like co <br />inform you that your request for a permit or license from the City of Orono or any of its <br />deparunents may require you to furnish certain private or confidential information. <br />You are notified rhat: <br />1. <br />., <br />3. <br />4. <br />5. <br />6. <br />The information you furnish will be used to determine your qualification for the <br />permit or license requested. <br />You may refuse to supply data, but refusal may require that the City deny the permit <br />or license. <br />The information may be shared with other local, state or federal agencies to the extent <br />necessary to process the permit or license. <br />If your requested permit or license requires Council action to approve, some <br />information may become public. <br />You have cenain rights under M.S. 13.04 (see followiq.g page) to review private data <br />on yourself. <br />Your full name is required to process this application or permit. <br />~- <br />First Middle <br />,J12.vJ M A:N j JF: a <br />Address <br />State <br />ts as stated above. <br />TELEPHONE -4UP357 • E.\X-473-0510