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f � <br /> �T+�r�'J� � 1 <br /> :� � <br /> x �� <br /> ��'' �`���k �y� � CITY of ORONO <br /> q p� � K1�1i � <br /> 1 1ro�: D r <br /> ��, ` a+,;, �'� <br /> -a"� '� �� '��� Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Officea <br /> ir ' '"` =# <br /> � `� �2'� <br /> s ' s • 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 Iike 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 /> 1. The information you furnish will 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 license. <br /> 3. The information may be shared with other Iocal , state or <br /> federal agencies to the extent necessary to grocess the permit or <br /> license. <br /> 4. If your requested permit or I.icense requires Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�� <br /> data on yourself. <br /> E. Y�,ur ful.I name is required to process this ap�%licaticn o� <br /> permit. <br /> � ` <br /> _ �,� C�Ll -f'�'Y' <br /> First Middle Last <br /> Address <br /> City State Zip <br /> Phone <br /> I understand my rights s stated above. <br /> Signa <br /> �� <br /> BUILDING&ZONING—473-7357 • ADMINISTRAT[ON&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />