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. � <br /> ���r�•'��. :?� <br /> � � <br /> ,< � �� � � <br /> ��:��� � �� -��,� � C ITY of ORONO <br /> s �� � <br /> �� j � Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> ,�r�.: s,.* ,, <br /> �' <br /> tf'�°".: -�4 f <br /> � - �A��'w�x' On the North Shore of Lake Minnetonka <br /> DATA PRIVACY 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 /> I.icense 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 /> qua].ification 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 ].icense. <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 CounciZ action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�at� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> m,cN+� L �'a�,v L�eoE►�ti�� <br /> First Middle Last <br /> 1 � 8 �S� I o 15-� �..�� �o • <br /> Address <br /> rn�\� � �o` � i���� ,� ss-�b� <br /> City State Zip <br /> yZ0 -� � 7 3 <br /> Phone <br /> I understand my rights as stated above. <br /> ��. <br /> Signature • <br /> BUILDING&ZONING—473-7357 • ADMIN[STRATION&FINANCE—473-7358 � PUBLIC WORKS—473-7359 <br /> ASSESSING <br />