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� � <br /> , . � <br /> �t.�a �: ;� <br /> � :��. ,.�.s�..�,�..� <br /> �a� �'�" w� � <br /> ���`� `�j �� CITY of ORONO <br /> �.� `�� =� <br /> ��� � '� <br /> '� � Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Offices <br /> s <br /> ' � - � ,� 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 /> 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 Iicense 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 �.ocal , 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 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 /> � , <br /> �- � ��� �,����--=� <br /> �--� C� y� /f��, - <br /> First Middle Last <br /> � r�''�� `j�� +�� �c�. �Ci <br /> Address <br /> -�_ �'_, /��'� _S �% <br /> ,__ <br /> City State Zip <br /> � '�, �- -� __�� �� <br /> ��� � ��-I s <br /> one <br /> I understand my rights as stated above. <br /> � � / - / �/ �, <br /> ,.� /� �`"��-�/�� � t._.�.� <br /> C ,L Z/�.._�- � �. l <br /> Siefnature <br /> �-. <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br /> � <br />