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� � (����" o� ����1T� <br /> Mf � <br /> Post Office Box 6b•Cr5'stal Bay, Minaesota 5a323•Municipai Offices <br /> � On the North Shore of Lake Minnetonka - <br /> s - • • <br /> DATA PRNACY ��SORY <br /> Subd. 2. "Rights of subjects of <br /> ou that your request for a permit or <br /> In accordance with M.S. 13.0 ► } require <br /> data" , we Would like to inform y of its depar�ments may <br /> license from the City of Orono or any <br /> Y <br /> ou to furnish certain private or coniidential inzormation. <br /> vou are notified that: <br /> 1. The inrormation you furnish wiZl. be used to determine yaur <br /> aualification for the pe=-:nit or license requested. <br /> � Z data, but resusal may require that <br /> 2. You may refuse to supp y <br /> the ermit or Iicense. <br /> tne City deny P S�ate or <br /> be shared with other local , <br /> 3 . Tho inrormation may <br /> rocess the pe=-mi� oi <br /> f ederal agencies to the extent necessary to p <br /> ?icense. • <br /> Iicense re�ires Councii a���°j <br /> �. li your requested per:nit or uDlic. <br /> ation may become p <br /> to aporove, some inform � v��e <br /> J � <br /> You have certain rights under M.S. 13.0� to rev=ew gr_ <br /> data on yourself. , <br /> o thiS �DDZ�ca�-or. or <br /> 6 . <br /> Your fu?1 name is required to proc_ss <br /> pe�it. <br /> �S `� /" ��;ti, <br /> : � <br /> -� /�" � �,�"� <br /> F��s� Middle <br /> Last <br /> � � / 'G� 1!`'/�� � <br /> Address / ���� <br /> � �� <br /> Sta�.e - <br /> City � �,, <br /> `��� �c�i <br /> Phone <br />�; <br /> I understand my rights as stated ab�- <br />� � �' ,_ � ������ ��. - . <br /> x � . <br />: zgnat�,r <br /> � � pDhiINISTRATION&FINANCE-��3'�358 <br /> • PUBLIC H'ORKS-473-7359 <br /> BUILDItiC&ZONING-4�3-%3.7 <br /> ASSESSING <br />