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� �. � i <br /> ��� <br /> l ^n.x� <br /> ��� � � 5 <br /> ��= � � CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Offices <br /> • <br /> • - • • On the Nor�h Slzore 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 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 license requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or Iicense. <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 reguires Counci3. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review prica�L <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ,�,� �� . �� �;C ��.✓�'�"�� <br /> First Middle Last <br /> .`(c,�'� �.i�(�'�-:� C- c� <br /> Address <br /> , �-�-�. <br /> C�c,�-�,�� � ti� � � � a � � <br /> City State Zip <br /> •� � � -- c� G. ( (� <br /> Phone <br /> I unde-rstand my rights as stated above. <br /> � �/ � <br /> ignatur . <br /> BUILDING&ZOlYING—473-7357 • ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />