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i <br /> �vr� <br /> 'xl^�>1 t ...� <br /> � �rl�� 1 7 S.. � <br /> � � ` � � CITY of �1�ON(� <br /> ��; <br /> - s :�v� � <br /> �R " : ; <br /> , �s � � Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • w � �� <br /> � _ � � ���•' On the North Shore of Lake lllinnetonka <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 refusa.Z 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 I.icense requires Council 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 procass this application or <br /> permit. <br /> Fi iddle Last <br /> Address <br /> � �3�3 9/ <br /> City State Zip <br /> �-l�/-dS`�3 Z <br /> Phone <br /> I understand my rights s stated above. <br /> Signat e - <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FIIYANCE—473•7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />