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:�. <br /> ��� t�Y �#�� CITY of ORONO <br /> ., ��; <br /> t'��r� . <br /> Post Off ce Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> � <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 /> license 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.l 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 Iicense. <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 Iicer_se requires Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 �o review prica�L <br /> data on yourself. <br /> 6. Yaur full name is required to process this aoplicatian or <br /> permit. <br /> t��.�-`C ��-, l_:,a.::ct-� <br /> First Middle Last <br /> �`�l.0 (�-��� �-�'�''�'' ��.J`TG�V� <br /> Address <br /> �'L?��t.x� U�l'�..1� ��12�-9� <br /> City State Zip <br /> ��1. - �z�-{ <br /> Phone <br /> I understand my rights as stated above. <br /> , �_. <br /> � � <br /> � , , <br /> , - _ , , <br /> Sign�t re ) <br /> , ( <br /> �� �� <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FIN,INCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />