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. <br /> . . . <br /> r '•� <br /> e <br /> t <br /> s a:��� <br /> x � <br /> � �-��t ��:. <br /> =�����- � CITY of ORONO <br /> :� i <br /> 1� Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> 0 <br /> � _ s � 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 I.ike 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 /> l. The information you furnish wil.I 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 information may be shared with other local , s�.ate or <br /> federal agencies to the extent necessary to process the permit or <br /> I.icense. <br /> 4. If your requested permit or license 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 /> /���S�L /�L•�/.��.�� `v��s i�� <br /> First Middle Last <br /> �3S/`��/ <'�,�5 T� i�� - <br /> Address <br /> ��/,� Z T� ���,� .��.��/ <br /> City State Zip <br /> � / �� � �/ 7� .�/ <br /> Phone <br /> I und�rstand my rights as stated above. <br /> ;' <br /> t`r,;. % �. <br /> �<. <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FIN��vCE— 473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />