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'�.�.,��-5� r��� ;�-. <br /> .,.:�'�* � �"�+- ,: <br /> -�--`� �^4Y",, <br /> r ar"+�{��. Fy}��F�-v�r�. <br /> `�� �� �� �i��� O� ����� <br /> f� :�� t: <br /> LL,u+,•. �,:,a;^�:,:: <br /> "'� 1::+�r- <br /> ` � Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> � �.. <br /> � —^°��:-r <br /> •��;,, A�. <br /> �:V'3' <br /> s ' e y ��� On the North Slzore of Lake Minnetonka <br /> DATA PRNACY 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 /> l. 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 snared with other Iocal , s`ate or <br /> federal agencies to the extent necessary to process the permit ar <br /> Iicense. <br /> 4. If your requested permit or I.icense requires Councii ac�ior. <br /> to approve, some information may become publ.ic. <br /> 5. You have certain rights under M.S. 13.04 to rev�ew private <br /> data on yourself. <br /> 6. Your fu.Il name is required to proc�ss this application or <br /> permit. <br /> � �� ���� �__ ��� ��l ;+ i <br /> First Middl.e Last� <br /> __1 �C� � � � 7<< E'��i L'Y l�> � 1%��C , <br /> Address <br /> -;� 11 )�� ��y�I/� ; � �-,� _��/ �-_ <br /> City State Zip <br /> �� 7 ,.� _ •--> --- <br /> -__���� � ���(�) -� � <br /> Phone <br /> I understand my rights as stated above. <br /> . <br /> .--,"" � /r,, <br /> _ � � <br /> �- <br /> ignatu�€ <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />