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. <br /> db,�E� � ` �i <br /> �� � � CITY of O�iONO <br /> �� Yi. <br /> �,.����� �wk. <br /> � .��Ss^E- .,�r,.. <br /> �Zs#«Yr�F��; <br /> ,��_.',�,� . <br /> �..tsrrxd:.J� . <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal ces <br /> • <br /> � _ e � 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 f rom 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 wil.l 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 loca3 , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Council ac��o^ <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priv�te <br /> data on yourself. <br /> 6 . Your full name is required to procass this applicatior. or <br /> permit. <br /> C.� �- T 1�q,^ �ti``-� �'o'� <br /> First Middye Las <br /> )�y� C�.��s a;�, �� <br /> Address <br /> M� `�� �c�ll <br /> L '����� � � -- <br /> �i�� _ Stat� Zip <br /> _ �111 -�16 � <br /> Phone _ <br /> I und�r t nd my rights as s�atEd abcve . <br /> , <br /> Signature _ <br /> BUILDIVG& ZONING—473-7357 <br /> • A��4IIdISTRATION.&FINANCE— 473-7358 • PUBLIC WORKS — 473-7359 <br /> ASSESSING <br />