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Y,, � � <br /> � =t' <br /> ^4. � "� <br /> lµ �, k'f � <br /> �3�� ` f� CITY of ORONO <br /> s_ � ��a: <br /> ��_: <br /> � - <br /> . "��''''.�`�; Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> _ � ,ti� y`, <br /> ,y,ti� .e','+. <br /> � - s��`e'�" 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 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 confidentiaZ information. <br /> You are notified that: <br /> 1. 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 license. <br /> 3. The information may be shared with other Iocal , state or <br /> federa]. agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Counci3. action <br /> to approve, some information may become publ.ic. <br /> 5. You have certain rights under M.S. 13.04 to review pri�at� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> ermit. <br /> �z �� � � �� <br /> First Midd e Last <br /> � �lrt� <br /> b <br /> r ss . <br /> U\ IQSS e.�..` N S � � <br /> City State Zip <br /> ���- S�si <br /> Phone <br /> `*� I u derstand my rights s stated above. <br /> � , <br /> � � <br /> 1 <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />