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��,_ - <br /> �, <br /> :�,�;,�-. <br /> ` __ ���� �� ���i�� <br /> � Post Office Box 66•Crystal Bay, Minnesota 5a323•Municipal Qffices <br /> i� <br /> � � �y . �. 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 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 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 ar <br /> license. <br /> 4. If your requested permit or Iicense requires Councii ac�ior. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full. name is required to process this application or <br /> permit. <br /> ���(� J� /2eo,0 <br /> First Middle Last � <br /> . <br /> �- �-/S ���w�a� r.,.J-¢-� F . <br /> Address, <br /> t✓�%?�rr��-- SS 3 � <br /> Ci� State Z1p <br /> y�, _ S s��� <br /> Phone <br /> I understand my rights as stated above. <br /> . � <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />