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� <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � - � � On the North Sh.ore 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 /> Iicense 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 license. <br /> 3. The information may be shared with other �ocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> l.icense. <br /> 4. If your requested permit or Iicense requires Councii action <br /> to approve, some inf ormation may become public. <br /> 5. You have certain rights under M.S. 13.04 to review privat� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> , ._ .� � <br /> � � � ; � . _ � � � � <br /> f, f <br /> First Middle Last <br /> i <br /> Address <br /> , ° r � <br /> City State Zip <br /> Phone <br /> I understand m right st ed above. <br /> gnature <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&.FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />