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�,; f� <br /> .. �� p <br /> ���:L'��� �'� <br /> 1 <br /> �������=� �g° ��� CITY of ORONO <br /> ��yt,�a ; i �, � <br /> �` M1.�YM+F�ASr4'S Z .� <br /> ��� . � <br /> .;? t� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal ces <br /> • R �.�' ���� . <br /> � _ ,� a`�� On the North Shore of Lake Minnetonka <br /> �:c: � DATA PRIVACY 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 /> 1. The information you furnish wil.l 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 other �ocal , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or 3.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 pri�a�� <br /> data on yourself. <br /> 6. Yaur full namP is required to process this applicatian or <br /> permit. <br /> ��� � �� C-�5`S ,� �--- <br /> First Middle Last <br /> O � T Cj � �j L� �O 1�-- ; O� \� <br /> Address <br /> Vv�v� s s3 � � <br /> City State Zip <br /> �� ( � �n�`F ��L��� ( �� I`�� C►--F l <br /> Phone <br /> I un ers an y rights stated above. <br /> ��-- �C <br /> Signa <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />