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. . � <br /> ���. <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> i <br /> s - � i 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 3ike to inform you that your request for a permit or <br /> 3.icense 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 Iocal , state or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or license requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.So 13.04 to review priva�E <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> �� {� ✓- <br /> �� �,S <br /> First Middle Last <br /> ��ls� �L��ie� �� <br /> Address <br /> :5��'!L� ��'}CcX�� /��Gt/r ���3 � <br /> City State Zip <br /> �f�`�--����f.5� <br /> Phone <br /> I u derstand my rights as stated above. <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATIOIY&FINAfVCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESS[NG <br />