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rrrr""'r"� <br />� �''�� . <br /> f�5���� <br /> y�t5�. 1Y. `� t'%: <br /> / 23! <br /> � ���-k,�,� �4 Q��ti�(�Y': „��l'`t. <br /> q f ����ti1,. <br /> � ���r�{��� ���ry�� CITY of ORONO <br /> + •,�'�i��yf�Y'�C�'J•"`'�7�',a: <br /> Y�4,����,'^,�l"A�y��� Jti ' <br /> Z <br /> ,�� Post Office Box 66•Crystal Bay, Minneaota 55323•Municipal Offices <br /> �{Y !v'.:�'hf '�ta�: <br /> !��,��' � . _ <br /> 4.N. ., <br /> �,�,:Y;?�;,.�. , .4, <br /> � _ � 0-�� 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 Iike 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 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 /> license. <br /> 4. If your requested permit or Iicense requires Counci3 action <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 application or <br /> permit. <br /> M�cSW.c'� .�-, UTf���Etz— <br /> . First , Middle Last <br /> 1�-�0 �3o�1-t•rs PrnNT �f�P <br /> Address <br /> o Rtr� M►.1 553�`i <br /> City State Zip <br /> ��- - o3�1Cc �WaP..K-� <br /> Phone <br /> 2 understand my rights as stated above. <br /> Signature . <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE —473•7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />