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^ ! <br /> -•a . <br /> s.�- ' <br /> ��a.. .(9 Zts:+'re� <br /> ���� <br /> �����`��y, �i��� O� ��.��� <br /> ��- Y;..::�,.h� <br /> .�._�: <br /> �-�;��:-�:,: <br /> ��1 �-r�:-': Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> � . <br /> : ";;;,; <br /> ��.���.:. <br /> • ..�. <br /> Y:'�=�r:,. <br /> � _ � '' 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 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 local , s�ate or <br /> federal. agencies to the extent necessary to process the permit or <br /> license. <br /> a, If your requested permit or license reguires Councii. ac��o% <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 ful.I. name is required to process this application or <br /> permit. <br /> � ���� � f �,,� � � c� _ <br /> First <br /> Middle Last <br /> /��5� S . �✓�o� v. �c� , <br /> Address <br /> � ��� � ss� � � <br /> City State Zip <br /> `�� �^ ��Z.� <br /> Phone <br /> I understand my rights as stated above. <br /> ,`� <br /> ' gnature � <br /> , • PUBLIC WORKS —473-7359 <br /> BUILDING&ZON[NG—473-7357 • ADMINISTRATION&FINAhCE —473-7358 <br /> ASSESSI;YG <br />