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� . . <br /> � <br /> b� F y`y,A <br /> N ��ti��� u. <br /> ��� ���� �.� ��� ����' o� (��0�� <br /> ,� t . � ,, :f <br /> ' aFt��;n7'''Fs� s. � ° <br /> �'�'f�t a�-�L';� , <br /> �� <br /> :� '���y ` r�'� Post Office Box 66•Crystal Bay, Minnesota�323•Municipal Offices <br /> ;e�.+.� <br /> , <br /> ��n�Yy�� <br /> ��i�''L On the North Shore of Lake Minnetonka <br /> <� w - • e <br /> c <br /> DATA PRNACY ADVIS�RY <br /> ��In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects o` <br /> data , we would Iike to inform you that your request for a per�it o: <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 /> 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 tha� <br /> the City deny the permit or Iicense. <br /> 3. The information may be shared with other Iocai , 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 Counci� action <br /> to approve, some information may become publ.ic. <br /> 5. You have certain rights under M.S. 13.04 to review prica�� <br /> data on yourself. <br /> 6. Your ful.l name is required to process this applicaticn or <br /> permit. <br /> ��'...1�� ��"N� �i..t_-�G_.,�- <br /> First Middle Last <br /> /'-�Cr� `� , �v ��f�-�.z- � � <br /> Address <br /> � ��Jf� ��� 3 �-`� <br /> '�c, .c,�c� <br /> City State Zip <br /> � 7 � — ��.Gc'� '► �/�� �7 �--' �' 3�` � ��'''� <br /> Phone <br /> I understand my rights as stated above. <br /> ��-- �.- ..� � <br /> Signature <br /> BllILDING&ZONING—473-7357 <br /> • ADMNISTRATION&FINANCE —473-7358 • PUBLIC WORKS —��3'�3�9 <br /> ASSESSING <br />