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z . , • <br /> � <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Offices <br /> • <br /> v - � � 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 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 wil.I be used to determine your <br /> gualification 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 Zicense reguires Council. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review privat� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> � <br /> � <br /> c,f `'"'� <br /> i st ddle Last <br /> /_G� 4 <br /> Ad ress <br /> /��'/ ,�� ,� � <br /> City State Zip <br /> S��-- �S'2 � <br /> Phone <br /> I understand y rights as stated above. <br /> , <br /> Si ature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATIO[V&FIN.V'YCE—473-7358 � PUBLIC WORKS—473-7359 <br /> ASSESSING ; <br />