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. r <br /> � z��ii�* <br /> i���•. ry <br /> -V��' �` � � CITY of ORONO <br /> �. ..�-�. <br /> ;- � �:� �} <br /> :�y� � �'��4:i Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> W'�� � . <br /> � - � � 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 /> 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 wi31 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 Iicense requires Council 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 application or <br /> permit. <br /> �-Q r I r e � c, ,-� « ���r L <br /> First Middle Last <br /> $ Y 5— � ( <br /> Address <br /> W cc E� d.�v r..o � S3—3 1 <br /> City State Zip <br /> � � y �� � � <br /> Phone <br /> I under and my rig s as stated above. <br /> ;�G <br /> Signat / <br /> BUILDING&ZON[NG—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />