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��`�,r r �Y ;,��.. ..6. <br /> ��_ ��� <br /> .{ r� �h <br /> =� M° ��� � �Y-� CITY of O��NO <br /> �,.���� ,,, <br /> � tµ� Y � �LL Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <br /> � - � � 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 /> 1. 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 1ocal , state or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> �CL YYI�� `��T"�C-�._ `(�� ���`- � - <br /> First Middle Last <br /> �(�jU � ��C�'�-2 �� `�r� <br /> Address <br /> _J''1 �r�rt�-��� . �'1 t�, ���G �- <br /> City State Zip <br /> � �Z--�( �S� <br /> Phone <br /> I understand my rights as stated above. <br /> �- <br /> i ! <br /> - � C�t... <br /> Si at re <br /> BUILDING&ZO:ViNG-473-7357 • AD'.�1INISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESS[NG <br />