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, <br /> � <br /> � � <br /> ���.�-��"��+r: <br /> ���� �r�. �� �I�Y o� �RONO <br /> �--� �,�-, �� � ;: <br /> s�. �� :� <br /> ������i':•�:�A�.'', <br /> �. --��;;; Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> X v-�� <br /> ' r..y���,�__' <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 3.ike 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 confidentia3. 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 license 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 snared with other Iocal , s`ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Councii. ac��or. <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 proc�ss this application or <br /> permit. <br /> , �,G � <br /> First Middle Last <br /> /�/� 7 ��f`/ F= <br /> Add ss <br /> '' �, � � .7 <br /> City State Zip <br /> �� %-���'� <br /> Phone <br /> I understand my rights a stated above. <br /> � <br /> Sign re <br /> BUILD[NG&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS —473-7359 <br /> ASSESSIN G <br />