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� <br /> . ����#� <br /> ����� <br /> ��r���� CITY of ORONO <br /> � � <br /> � .. <br /> y,.�: <br /> �� �.� .�, �,c <br /> _,,,�� r� Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Officea <br /> � <br /> � m +� � a On th,e 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 like 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 /> 1. The information you furnish will 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 iocal , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Councii. action <br /> to approve, some information may become publ.ic. <br /> 5. You have certain rights under M.S. 13.04 to review pricat� <br /> data on yourself. <br /> 6. Yaur full name is required to process this apFlicatian or <br /> permit. <br /> LEG�1 �L1 CiCIt.'� �7RLl.' f���IV� <br /> First Middle Last <br /> C'1 Z�:'-- D ��kc; r� AU�� <br /> Address <br /> � <br /> 1��,ti'�; L r�k� n1 �' .�:�_3.�� <br /> City State Zip <br /> � 7� -Z4 �� <br /> Phone <br /> I understand my rights as stated above. <br /> �i�^� C� c;�.�2C.�� J,` `�� �� <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&F(NANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />