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• . . <br /> ��� ., ti <br /> �� �� �� ��� �` CITY of OR011'�TTO <br /> � � <br /> .f`�* � ' � Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> ; Y'wt�,:'�.. <br /> � - s � 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 /> 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 /> qualif�.cation 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 Iicense. <br /> 3. The information may be shared with other iocal , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> �� ;;7 �iz.i�'i�'i7 ��l�E'��l�U ilZ <br /> First Middle Last <br /> /�Z-�j �l r`��f r.�G'�l7 L-d� <br /> Address <br /> L2;%���7�s�T F-k /"�'1 i't�' S���J� � <br /> City State Zip <br /> � �� ��,�5' , <br /> Phone <br /> I understand my rights as stated above. <br /> ��� � � <br /> �, �' �r .cr��i'�1✓�i'� <br /> Signature <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />