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�w�.;,: • <br /> a, . <br /> � ��`�y. <br /> ��� ��d � � <br /> .�.�H �����;� C ITY O� OR�l\T <br /> .r <br /> �;�.. <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•1�'IuniciPal Offi�es <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 Iike 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 /> l. The information you furnish will 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 Iicense. <br /> 3. The information may be shared with other local , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> I.icense. <br /> 4. If your requested permit or Iicense requires Councii ac��or. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your ful.l name is required to proc�ss this application or <br /> permit. <br /> M ;���,.�1 <br /> ,�te� /�';�y`C� �E'.N 0 rn�� <br /> First <br /> Middle Last <br /> /l/��/ �'��,rr ,��� � E- <br /> Address <br /> . �.3�,�t�o�.��. ,�. r�s 5����� <br /> City <br /> State Zip <br /> f�5- �`�`�� <br /> Phone <br /> I understand my rights as stated above. <br /> ��� ��- ^-.� <br /> Signature � <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />