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, � . . <br /> 1 <br /> y� <br /> �I. <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Officea <br /> • <br /> s ' s • 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 /> license 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 will 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 license. <br /> 3. The information may be shared with other local , state or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or 3icense requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> l Caw ��1� aN -�,2 � � Kso1�� <br /> First M ddle Last <br /> 3 a � S' �-�.� <br /> Address <br /> '�..� 5�� .5 ��-z 7 <br /> City '� State Zip <br /> .S--y� -- `�,�� � <br /> Phone <br /> 2 unders nd my rights as stated above. <br /> ignature <br /> BUILDING&ZONING—473-7357 • ADMINISTRAT[ON&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />