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�� - � <br /> ,�� .,� �\�� r� �°;, <br /> .,� � � <br /> ,, � ��:.� :� (�I'�Y O� OA��N� <br /> ��,;; ��� .�.� <br /> '�,� r-� r ;�; <br /> x �r. k�'t'�"; `�`�� <br /> �'" : r <br /> 'T Post Office Box 6&•Crystal Bay, Minnesota 55323•Municipal Offices <br /> 0 <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 Iike to inform you that your request for a permit or <br /> license f rom 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 inf ormation you f urnish wi I 1 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 Iicense. <br /> 3. The information may be snared with othTocesscthe permit or <br /> federal. agencies to the extent necessary to p <br /> �icense. <br /> 4. If your requested�p��n may become pub�u� res Councis ac��or. <br /> to approve, some info <br /> 5 . You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6 , Your full name is required to proc�ss this appl.ication or <br /> permit. <br /> ��C�,_�C� �L'3�.`�rC�L ��;X:s.,� <br /> First <br /> Middle + Last <br /> \ � � �-G��\`� <br /> ��� �a�� o <br /> Address <br /> - ;�� \`� ��t��'L. rT���D�� <br /> City State Zip <br /> �-�� - y�-�y � <br /> Phone <br /> I understand m rights as stated above. <br /> ,�% '� �,,,� <br /> Signature <br /> BUILDING&ZONING-473-7357 • aDMINISTRATION&FINANCE -�73-7358 <br /> • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />