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+ , . <br /> ��-�� � <br /> ' a� � -, <br /> ;:�� � � � � � (iT�� O� �R�1�� <br /> ��� �� .� <br /> �� 4�x� .�� <br /> �'�,_,. � Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> ,r a'1 � �� � <br /> 'P�1 rv c^ <br /> � �'�� X�r ,� >� 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 /> Zicense 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 /> I. The information you furnish wi1.1 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 3icense. <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 Counci� action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 �o review priva�e <br /> data on yourself. <br /> 6. Yaur full name is required to process this applicatian or <br /> permit. <br /> � <br /> �,c�-� ��c,S�S � � <br /> First Middle Last <br /> -"�j �j�v Jc��5�-�� �`^�- <br /> Address <br /> L� ��� � ��� ��3 � � <br /> City State Zip <br /> �I --� cl - ZS'�c:� � <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILDING&ZO[VING—473-7357 <br /> • ADMINISTRATION&FINANCE—473-7358 � PUBLIC WORKS —473-7359 <br /> ASSESSING <br />