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� <br />� ' � (a���" o� ���NO <br />� <br />� � esota 5a323•Municipal Offices <br /> Post Office Box 6F'C�S'S�Bay, Min� <br /> rt N w <br /> � � <br /> On the North Shore of Lake Minnetonka <br /> • ' • • <br />$ DATA PRS�T.�C� ��SORY <br />' Subd. 2, "Rights of subjects of <br /># ou that your request for a permit or <br /> InWe wouldnlike to i form3y04, uire <br /> i data" , of Orono or any of its departments may req <br />( license from the CitY rivate or confidentia� in=ormation. <br />� you to surnish certain p <br /> s <br />� you are notified that: <br /> i. The inFormation you furnish will be used to determine your <br /> qu <br /> alification for the pern=-� or license requested. <br /> 2. You may <br /> refuse to supply data, but refusa3. may require t a <br /> the City deny the permit or license. <br /> be shared with other Iocal , s�ate or <br /> I e*-mit or <br /> 3 . The information may to process the p <br />� federal agencies to the extent necessary <br />' �icense. <br />� Iicense reau�res Councis a��'-°r <br />� a. If your requested pe=mi� °r ublic. <br />! �nformation may become p <br /> `� approve, some . } <br />� hts under M.S. 13.Oa to review pr�Vc�e <br /> ;,. You have certain rig <br /> data on yourself. <br /> 6. Your fu?1 name is required to process th's appl=cat�on or <br /> per•nit. <br /> F�rs` Middle <br /> Last <br /> Aaaress <br /> Citv <br /> State Zip <br />; phone <br /> II understand my rights as stated abave. <br />�, <br />�: . <br />,, <br />,�: � <br />�: . � . <br />; Signature <br />� <br /> � ADMI."rISTRATiON&FINANCE—473-7358 <br /> • PUBLIC WOR� —473-7359 <br />� BUILD[NG&ZONING—4�3-%357 <br />� ASSESSIN G <br />