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CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> • • • • On the North Shore of Lake Minnetonka <br /> Dr'�TA PP.IVACY AUVISC3RY <br /> Tn accordance �rith M.S . 15 . 165, "Righ�.s of sri�ja��c:ts of dat�" , <br /> we wo�xlcl like to inform you th-at your request for a �ermit or <br /> license from th� City af Orono or any o£ its dep�rtm�n�s m�y <br /> require y�u �co furn�.s➢� c�rtair, private or confidenti.a�. �.nform- <br /> ation. <br /> You are notified t:��t: <br /> 1 . 'Z'he ir:form�tion yot� furnish will be used to ,3�termine <br /> your qualificatian far �he ge�rmit or license requ�sted . <br /> 2 . Ycu may r�fuse to sugply dat�, but refusal may require <br /> that the Ci�y d�ny �kie �erma_� �r licensu . <br /> 3 . The inf.ormation may be shared �ai��: o�her local. , �tate <br /> ear federal agencies to t}ie extent necessarv �o process <br /> the �ermi� or license. <br /> �4 . If yaur r�quested permit c�r lieense rFgzres council <br /> action to approve, some in�oimatian In�-�v becom� public. <br /> 5 . �au r�avc� certian rights und�r M.S . 15 . 165 tQ review <br /> pr:ivdte data �n yaurself . <br /> 6 . Your fulJ. name, and dat� �f birth are requir�d to proceas <br /> this appli_�ation or permi.4�. <br /> ,' <br /> i <br /> - � � S � � _ � '` �2% <br /> Firs d�.le I.ast <br /> �?� �� `, �.�v'/P� � �s�� <br /> A�dress �' <br /> ��,�'`;�?)C'3 ��%1��%2J, �✓�� `� �_ <br /> Dat� of birth (3oes not apply to building./genEral permits) <br /> ���������� <br /> Phone <br /> T understund rn� r ' ts s stated abov� . <br /> '1 ' <br /> / ' <br /> ,. <br /> �� - <br /> ( c�natu .e � � <br /> BUILDING&Z ING—473-7357 • ADM1N[STRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />