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- M <br /> ` <br /> _.�*x�..�- '�� _ <br /> ;� Y - � ��"� C���' o� ���1�7� <br /> L .' ,�� <br /> �`;'''�`�`` Post Office Box 66•Crystai Bay,Minnesota 55323•hlunicipal Offices <br /> � .:��` <br /> ,.,�� <br /> 0 �'";, ,.: <br /> �. _ � � o� On the North Shore of Lake Minnetonka <br /> DATA PRNAC�' ADVISaRY <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 /> 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 will be used to determine your <br /> aualification 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 local , s�ate 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 ac��or_ <br /> to approve, some inforntation may become �ublic. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your fu3.l name is required to proc�ss this application or <br /> per•nit. <br /> �Ui2T -�� � i � <br /> First Middle Last <br /> .���� �U- ������1 <br /> A ress <br /> I�-���S� /�( , <br /> '�5�(�� <br /> City State Z�P <br /> ,�����b��1 <br /> Phone <br /> I u er t my rights as stated above. <br /> �— <br /> Si tur • <br /> l <br /> BCJILDING& ZONING—473-7357 <br /> � ADMINISTRATION&FINANCE — �3%3-7358 • PL'BLIC WORKS —473-7359 <br /> ASSESSING <br />