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� � <br /> =�:`_� ��_ - <br /> �.-�, � .,� <br /> z� <br /> ��TI' o� O�►OI\T� <br /> � • Post Office Box 66•Crystal Bay, Minnesota 5�323•Municipal Offices <br /> ` � <br /> i: <br /> ' ,� _ a �� On the North Shore 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 /> Zicense 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 /> l. The information you furnish Wiii 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 snared with other Iocal , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your reauested permit or Iicense requires Council ac�ior. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> � <br /> o,��T J 1�m��s �► ��. <br /> First Middle Last <br /> 34 t3 �n� s �r�� �� � �� <br /> Address <br /> L�/�t Z� T"� /?� ��31`�� <br /> City State Zlp <br /> �71-��2 � <br /> Phone <br /> I understand m rights as stated above. <br /> � ` <br /> r <br /> Signat re <br /> BUILDiNG& ZONING—473-7357 • ADbfIN1STRATION&FINAtiCE —473-73�8 • PUBLIC WORKS —473-7359 <br /> ASSESS[N G <br />