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. � , <br /> : .v.,. <br /> :w;= <br /> � , " <br /> � . <br /> r <br /> � � CITY of ORONO <br /> ��� .�. <br /> � <br /> s.._,.��'� rt��, ;�i` <br /> � <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <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 /> 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 /> l. The information you furnish will be used to determine your <br /> qualification for the permit or l.icense reguested. <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 Council. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�� <br /> data on yourself. <br /> 6. Your full name is required to process this apF.Iication or <br /> permit. <br /> .�r.:F �,�� �.r«� <br /> First Midd e Last <br /> �%y� /- ' "z �_ <br /> lk��C% y� t �V � <br /> Address <br /> , <br /> .�' > � '�����`�F <br /> City State Zip <br /> � 1�7�.- ���i��`� <br /> Phone <br /> I understand my rights as stated above. <br /> c' �� <br /> Sign�ture � <br /> \ - - <br /> BUILDING&ZONING—473-7357 • ADMIN[STRATION&FINANCE—473-7358 • PUBLIC WORKS 473 7359 <br /> ASSESSING <br />