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� \ c <br /> ,,:.�r �` .� 3 <br /> ,�-;:'' ','�:�, a \ <br /> �.�- , , �,�,.,f�� S� <br /> �N <br /> ���.,:��� a <br /> �� �` C IT�' of ORON� <br /> =�- .� <br /> � t TM JY �M <br /> il <br /> ' '�' ``� u' Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> � �'�+ <br /> � <br /> .+ <br /> ` '. o;'� 9` <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 /> 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 wil.l. be used to determine your <br /> ��� qualification for the permit or Iicense requested. <br /> J� <br /> x 2. You may refuse to supply data, but refusal may requirp that <br /> �`�� the City deny the permit or license. <br /> c� <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 /> Iicense. <br /> 4. If your requested permit or Iicense requires Councii act�or. <br /> to annr_ave, 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 �o process this application or <br /> permit. <br /> ��'�-�'�U �-- �},-���- s°c,�✓ �-{E�' S � r� � <br /> First Middle Last <br /> 1 (v Q �... � . C.�L� ��f- �'`�0 A-1� <br /> Address <br /> '� J�,�,v,il� V�+J S'.� �3� � _ <br /> City State Zip <br /> �i �f _ �3� 1 <br /> Phone <br /> I understand my rights as stated above. <br /> � � ` ,� 1�� <br /> � <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE —473-7358 � PUBL[C WORKS —473-7359 <br /> ASSESSING <br />