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CITY of OIZ��O <br /> Post Office Box 66•Crystal Bay,Minnesota 5b323•Municipal Offices <br /> 9 <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 /> Iicense 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 wiI]. be used to determine your <br /> qualification for the permit or Iicense 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 Zocal, 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 pub].ic. <br /> 5. You have certain rights under M.S. 13.04 to review pri�at� <br /> data on yourself. <br /> 6. Yaur full name is required to process this apFlicatian or <br /> permit. <br /> ��Y�PS �d-- La S� /-t` �f�1�P� <br /> First Middle Last <br /> I��� A�r(�� S1- <br /> Address <br /> (,�.�� �z�� Vvt.�� ����i � <br /> City State Zip <br /> u-��� -u��3 � <br /> Phone � <br /> I understand my rights as stated above. <br /> � <br /> � <br /> i a e • <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 � PUBLIC WORKS-473-7359 <br /> ASSESSING <br />