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,s,.:.:-.�` - � °I� <br /> .,: ,.' ; <br /> ���N <br /> � CI'��' o� �ROl\TO <br /> � Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <br /> s _ � o 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 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 /> 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 , s�ate or <br /> federal agencies to the extent necessary to process the permit ar <br /> license. <br /> 4. If your requested permit or Iicense requires Councii act�o^ <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 /> �rmit. <br /> �� i <br /> 1�,,\ e � � � � Z <br /> �. 1 Cc �— � <br /> rst � Middle Las <br /> , � <br /> � �� ��� <br /> Add e�s � , <br /> ; � '' � - - -� � C <br /> i ; , � �� � .- <br /> , <br /> �ty tate Zip <br /> , �/ �� <br /> Phone <br /> 1I u erstand my rights as st ted bove. <br /> 1 <br /> , <br /> ,.. , - <br /> �,_ �_ <br /> re . � <br /> BUILDING&ZONING—473-7357 � ADMINISTRATION&FINAYCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSIN G <br />