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, � , z <br /> CITY of ORONO <br /> Post Office Bou 66•Cryatal Bay.Minnesota b5323•Municipal Offices <br /> • <br /> � • � � On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", 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 require <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your <br /> qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or license. <br /> 3. The information may be shared with other local, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Council. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review privat� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> d � �'�b��i�ff V� �lA.�I;��(3� <br /> First M ddle Last <br /> �-1 (�(a ��r��� l�� <br /> Address <br /> v�J� f� �1-�- <br /> City State Zlp <br /> �� � � � I I <br /> Phone � <br /> I understand my right as stated above. <br /> Signature . <br /> BUILDINC&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING - <br />