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.., <br /> .>'9' ,.Y.h� <br /> �^t�'�.�:s`� ` r%3�... ,. <br /> Y�.:�sr �����#���� <br /> y�� � ��.��.��- CI'I`7�' O� OI$O�TO <br /> ��;�.I,..�,�-��, � .s-�; - <br /> .w ,zj,�,�,�,� �'��'�::r�. <br /> -`,.�"�.�:�' �. " ��,,�� <br /> ;;`..�,;� o-i ,:�,��:: Post Office Box 66•Crystal Bay,Minnesota 5�323•MuniciPal�� <br /> .�-.�- -,� -�Y <br /> ,`�� . � J�za�: <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 /> license 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 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 /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights ander M.S. 13.04 to review pri�at� <br /> data on yourself. <br /> 6, Yaur full name is required to process this applicatian or <br /> permit. <br /> Fi st <br /> iddle Last / <br /> ��d � ����rfL� <br /> Address <br /> G-L_._. �, �.� SS 3 s,� <br /> City State Z1p <br /> �7 6 - a � ��- <br /> Phone <br /> I understand my rights as stated above. <br /> Signa re <br /> BUILDING&ZONING—473-7357 • ADMINISTFtATIO`1&FINANCE—�73-7358 <br /> � PUBLIC WORKS—473-7359 <br /> ASSESSI;VG <br />