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.>-....::.,.. <br /> �� - <br /> _ i � _ <br /> �-� ����' o� ����T� <br /> � aa <br /> � Post Office Box 66•Crystal Bay, Minnesota 5a323•Municipal Offices <br /> 01 <br /> � � - a �� On the North Shore of Lake 1�linnetonka <br /> DATA PRSVACY ADVISORY <br /> In accordance with M.S. I3.04, Subd. 2, "Rights of subjects of <br /> data", we would Iike to inform you that your request for a permit or <br /> Zicense 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 /> cua�.izicat�on for the permit or license recuested. <br /> 2. You r,tay refuse to supp?y data, but re=usal may require that <br /> the City deny the permit or license. <br /> 3 . The information may be snared witn o�zer iocal , s�a�e or <br /> f ederal agencies to the extent necessary to process tne permit or <br /> iicense. <br /> a. If your requested per^tit or Iicense _ecuires Councii ac�io% <br /> to approve, some infor:nation may become pub?ic. <br /> 5 . You have certain rignts under r1.S. 1� .C � to rev�ew priva�e <br /> data on yourself. <br /> 6 . Your fu1l name is required to proc�ss this appZication or <br /> per;nit. <br /> �� � � � ��(��" �`- <br /> FirSt Middle Las� ' <br /> �� � �(/✓%` % <br /> Add��ss � <br /> :��.� �.-,� /�lG�, , ���� � <br /> C ' ty State Zip <br /> ---�`�;'��-- � �32- � <br /> Phone <br /> I unde=stand my rights as tate ab e. <br /> v <br /> Signature , � <br /> , • <br /> Bli1LDf�G& ZO�I`G - 473-7357 • ADStINISTRATION& FN�NCE - 473-73:3 • PUBLIC�VORKS -473-73�9 <br /> ASSESS[v G <br />