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, • � <br /> sr <br /> • ��� q <br /> 'a,,, � ;.,h *�-r,,+7 <br /> ��S <br /> ����� � <br /> ��� ��� � �� CITY of ORONO <br /> `�ly�. y��, �� � <br /> +�'°Y�, "`"�"' c � <br /> r°�^��:"��'�"+ Post Office Box 66•Crystal Bay, Minnesota 55323•Municipa] Offices <br /> y ``_A}� ��.`a <br /> �n �„r��� r:7 -. <br /> �� a 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 Zike 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 /> l. 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 Iicense. <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 Councii. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Yaur full name is required to process this applicatian or <br /> permit. <br /> ��"S`" � LtSS�� � � �� _ � <br /> First . Middle L st <br /> _3.��� G��,� 7��� ���, <br /> Address <br /> ��nG �i� � �N� �. <br /> Cit State Z: ! <br /> �> � ' ��� <br /> �/��`"7 7�' � ` �� <br /> Phone <br /> I understand my rights as stated above. '��'��^i1 '�� � <br /> /r <br /> �U"�J �G�71Y� 1 � `/��C ' (� 1� ' \ <br /> 1 <br /> Signature � T 1� �� ��`� �� � <br /> � l <br /> BUILDING&ZONING- 473-7357 • ADMINISTRATION&FINANCE-47; �� ( �� � � �� �} ��� �'" <br /> \ <br /> ASSESSING ; � � � Q� S� � \n� �� <br /> t� � <br /> � i <br />