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� _ . <br /> � , <br /> _ �I'��i' O� OR�II\TO <br /> L. !! ��'" Post Office Box 66•Crystai Bay, Minnesota 55323•Municipal Offices <br /> • <br /> s � o o 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 /> 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 wil.l 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 Iicense. <br /> 3. The information may be shared with other local , s�ate 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 ac��or. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6 . Your full name is required to proc�ss this application or <br /> permit. � <br /> � � � ��lD�s J�i�� ���f6�� <br /> ��/ U��A � � Last <br /> First Middle <br /> ���2� �11��� � - <br /> Address ✓� `��� ����� <br /> ,/''����- �1�)� <br /> City State ZiP <br /> � �- l� � � <br /> Phone <br /> I unde sta my ights as stated above. <br /> Signa • � <br /> BUILDING& ZONING—473 357 <br /> • ADMINISTRATION&FINANCE—473-7358 � PUBLIC WORKS—473-7359 <br /> ASSESSING <br />