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- ., <br /> � �;.�� <br /> �,j CITY of ORONO <br /> �� C.,.Y <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Officea <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 /> l. The information you furnish wiZl 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 grocess 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 �o review pri�a�� <br /> data on yourself. <br /> 6. Yaur full name is required to process th�s aprlication or <br /> permit. <br /> ��R�, L C�o � �c L� S!`t/ 7<'� <br /> First Middle Last <br /> f z � C �-{E �� C(�l a4 S � �� • - <br /> Address <br /> o ��►� � r-� � .�� 3 � � <br /> City State Zip <br /> �f 4 �=l ' �( �Z � <br /> Phone <br /> I under and rig ts as sta <br /> . <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FIN,aNCE —473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />