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. l <br /> G ITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <br /> • <br /> � _ � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.Sorm3'ou/thatdyour request for a perm t or <br /> data", we would like to inf Y <br /> I.icense from the City of Orono or any of its departments may require <br /> you to furnish certain private or confidentia]. information. <br /> You are notified that: <br /> 1. The inf orma�i�heY°ermit nor li ensebrequest�d,determine your <br /> qualification fo P <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or l.icense. <br /> 3. The information may be shared with other Iocal , et�i� oT <br /> federal agencies to the extent necessary to process the p <br /> license. <br /> 4. If your requested at on may become public res Council. action <br /> to approve, some inform <br /> 5. You have certain rights under M.S. 13.04 to review prica�L <br /> data on yourself. <br /> 6. Y�ur full name is required to process this apglicatian or <br /> permit. <br /> Steven Blair <br /> First <br /> Middle Las <br /> 13895 Industrial Park Blvd <br /> Address <br /> 55441 <br /> Pl�tmouth MN <br /> City State Zip <br /> 553-9369 <br /> Phone <br /> I understand my rights as stated above. <br /> ,� _ � � <br /> i" ✓� <br /> Signature � <br /> / • PUBLIC WORKS—473-7359 <br /> BUILDING 8c ZONING—473•7357 • ADMINISTRATION 8c FINANCE—473-7358 <br /> ASSESSING <br />