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. � <br /> ,�?��. <br /> k• <br /> � �t " <br /> `� � � ��� ��.� .' ��� O� ���1�� <br /> ,��.z� ,� � � <br /> CT C y.d'° �., <br /> g1����f',r'�,. <br /> } ���t�� <br /> Post Office Box 66•Crystal Bay, Minnesota a5323•Municipal OfSces <br /> i" <br /> • <br /> � _ e � On the North Shore of Lake Minnetortka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of <br /> data" , we would like 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 refusa3. may require that <br /> the City deny the permit or Iicense. <br /> 3. The iniormation may be shared with oth=o esscthe p rmit or <br /> federal agencies to the extent necessary to p <br /> license. <br /> 4, If your requested permit or Iicense requires Council action <br /> to approve, some information may become publ.ic. <br /> 5, You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Your full name is required to process this applicaticn o� <br /> permit. <br /> ��y �U�. .�` <br /> First Middle Last <br /> � � C� �rz-cz�--r-�' �v�s <br /> Address <br /> r �,�.r��,�ar ����.( �-i � J�"[ � <br /> ���r� <br /> City State Zip <br /> �2 c� ` ��3 S <br /> Phone <br /> I understand my rights as stated abcve. <br /> � <br /> Signature <br /> BUILDING&ZOMNG—4�3-�357 <br /> • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —��3-�359 <br /> ASSESSING <br />