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� <br /> ��- � <br /> �- �.�,"� �`' <br /> �� � � �� �I�� �� ����� <br /> ���x•t�:�. <br /> ���-� <br /> ���u <br /> r�� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> .z.-=�=. <br /> ! <br /> i _ � � 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 3.ike 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 /> l. The information you furnish wil.l be used to determine your <br /> qualification for the permit or license 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 /> f ederal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Councii ac�io% <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 /> �� � r' l�!�i(,l,i^�f���' �c� �� � <br /> irst Middle Last <br /> ) i � r� J l.,v , � � � <br /> Address <br /> � ��t-- V V�Y" ` S� T 7 � <br /> �� �� <br /> City State Zip <br /> �l i � — ? � �' ; <br /> Phone <br /> I understand my ri ts s S �ed above. <br /> �y <br /> � <br /> �, <br /> nature <br /> BUILDING&ZONING—473-7357 <br /> • ADMINISTRATIO[Y&FI[YANCE—�173-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />