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� - � <br /> �.�„�„� '��� n�:� <br /> � ��..��,. <br /> ,,�-�� '� ��. <br /> � ��' �rA C ITY o� OI�ON <br /> �?�yg+ 3,. -a.�,� <br /> �i��� <br /> .,.'"p,�;; Post Office Box 66•Crystal Bay,Minnesota 55323•IvluniciPal 0��� <br /> F� .. <br /> e � <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 /> Iicense 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 snared with other Iocal , s�ate or <br /> federal. agencies to the extent necessary to process the permit or <br /> I.icense. <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 priva:.e <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> � �� �� G��.� e e � � <br /> `5 � Last <br /> Firs Middle <br /> � � �/r �v <br /> Address <br /> ��'�.��/ ,�/�� �� �� ����__ <br /> City State Z1D <br /> �%� �i�� -3.��3 � <br /> Phone 5% �i -�-f� <br /> I understand my rights as stated above. <br /> �� <br /> Sign re � <br /> BUILDING&ZONING—473-7357 <br /> � ADMINISTRATION&FIfYANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSIN G <br />