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A y <br /> �f � �a'tir <br /> �4� ;i � t � C ITY of OROl�TO <br /> , ,. <br /> ; �n , ' `' Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Officea <br /> -r-' . <br /> y+•l�` � <br /> . - � g 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 3ike to inform you that your request for a permit or <br /> l.icense 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 3icense. <br /> 3. The information may be shared with other local , 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 Council. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ���,�� � ���� - <br /> First Middle Last <br /> 7`�/ /�'�f�f ��( �,��v�� <br /> Address <br /> �'�(�u�.�l� �'�Il�' S�� � `f <br /> City State Zip <br /> � ���-� � �� <br /> Phone <br /> I unders d my rights as stated above. <br /> � <br /> �� l."/� � <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />