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' � �,, <br /> �,���:����'�r� <br /> ��`."�"y tts- <br /> � � <br /> � �at �.2 <br /> ��'�� ��� �x '��� CITY of ORON� <br /> `; '�''�.� <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <br /> • <br /> • - • • On the North Sh.ore 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 3.ike 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 /> 1. The information you furnish will be used to determine your <br /> qualification for the permit or license requested. <br /> 2. You may refuse to suppl.y data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may be shared with other �ocal , 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 priv a�L <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> _ . �;,. - <br /> � �� �1-�l< <br /> �`��:; <br /> First Middle Last <br /> � � � ��� � <br /> � <br /> Address , <br /> j. e��. , ��-� " . . <br /> City State Zip <br /> , �� <br /> . � . �- <br /> Phone <br /> I understand my rights as stated above. <br /> ,. r � � �/ <br /> i/-�/1����' °�' ;/',t�''U //�,1���`._ <br /> � �, �� � <br /> Signature <br /> BUILDING&ZOIYING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />