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• i <br /> I� <br /> � � .. <br /> CIT�' of O1�ON0 <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � . ! • On the North Shore of Lake Minn.etonka <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 /> 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 wi11 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 shared with other Iocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or 3icense requires Counci 1 action <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 process this applicatian or <br /> permit. <br /> �. `I--c�Ul �7/ ' I�C �-S <br /> First Middle � Last <br /> r1�"lC��-"5 ����O -'O I Ui i ��r'J� <br /> Address <br /> �F 5���i1 <br /> City State Zip <br /> 4� 1 `� � �� <br /> Phone � <br /> stand my i hts as stated above. <br /> �� <br /> ; <br /> S re <br /> BUILDING&ZONING-473-7357 • AD�tINISTRATIOIV&FINANCE-473-7358 • PUBLIC WORKS -473•7359 <br /> ASSESSING - <br />