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r r . �. <br /> � <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minneaota 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 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 /> 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 license. <br /> 3. The information may be shared with other iocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or ?icense requires Counci i actio*� <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�e <br /> data on yourself. <br /> 6. Your full name is required to process this apglicatian or <br /> permit. <br /> ��ll'1e�2 �l�S c�� <br /> First Middle Last <br /> �� L/� �a�Ul�c� ��.a c� <br /> Address <br /> �� z�-� vr��� �� ss3 <br /> City tate Zip <br /> �7/-- C�s`-� / <br /> Phone <br /> I understand my rights as stated above. <br /> S ' n ture � <br /> BUILDING&ZOMNG-473-7357 � ADMINISTRATION&FINA.*10E-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />