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� � � <br /> � <br /> CITY of ORONO <br /> Post Office Bou 66•Crystal Bay,Minnesota 55323•Municipal Offices , <br /> � • <br /> � - � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY 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 /> ].icense 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 3.icense requires CounciZ 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. Yaur ful]. name is required to process this applicatian or <br /> permit. <br /> � ����i'"t-L � <br /> ¢ t.�� �� 1�h�. <br /> First Middle Last <br /> .�� -� `7� I�.���� L,�, . t�, <br /> Address <br /> 1 V \�-#�l� �'�� c�e} i� /t�.l ��J .�� �? <br /> City State Zip <br /> �37- � %�v <br /> Phone � � <br /> I understand my rights as stated above. <br /> . � <br /> i ature . <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />