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� �.. <br /> �.�� , <br /> �. <br /> ��. <br /> ''�� � <br /> A>.. <br /> �.� ������� C�'�Y o� ��ONO <br /> ��.,r <br /> 0�1 ' Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> ! <br /> i _ � � 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 /> 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 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 Iicense. <br /> 3. The information may be shared with oth=�r essCthe permit or <br /> federal agencies to the extent necessary to p <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 grivate <br /> data on yourself. <br /> 6. Your full name is required to proc�ss this application or <br /> permit. <br /> First <br /> Middle Last <br /> Address <br /> City State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILDING&ZONING—473-7357 <br /> • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />