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' • <br /> : �� � _ <br /> � ����'" o� (����T� <br /> � <br /> � <br /> � Post Office Box 60•Crystal Bay, Minnesota 5�323•Municipal Offices <br /> 0 <br /> s ' a g� On the North Shore of Lake Minnetanka <br /> DATA PRI�TACY 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 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.l be used to determine your <br /> cualification for the Der.nit or Iicense recuested. <br /> 2. You may refuse to supp?y data, but r�rusal may require that <br /> tne Citv deny the pe�it or iicense. <br /> � . The inrormation may be snared with otze� iocal , s���e or <br /> federa� agencies to the extent r.ecessary to proc�ss tne pe*-:nit or <br /> iicense. <br /> a. If your requested pe�.it or Iicense ;ecuires Councii ac��o% <br /> to a�prove, some inzor.nation may become pub�.ic. <br /> � . You have certain rignts under M.S. ?3.0� to review private <br /> data on yourself. <br /> 6. Your fu.I1 name is required to process this application or <br /> per:nit. <br /> First Middle Las� <br /> Address <br /> City State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br />�1LDING 3c ZOVIVG — 473-7357 • ,�DtitivISTRATION& FINAVCE — 473-73�3 � PUBLIC WQRKS —�273-73�9 <br /> ASSESSIY G <br />