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,��� <br /> � ���.r z y� �, <br /> ,�- � ,r3 <br /> n'�r � <br /> R � s� {?t <br /> �� � CITY of ORONO <br /> � � <br /> � :����� <br /> ;..��.;;�;, Post Office Box 66•Crystai Bay,Minnesota 55323•Municipal Offices <br /> f�J i'<`,, ...� <br /> � - � � On the 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 Iike 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 /> qual.ification 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 local , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or 3.icense 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 applicatian or <br /> permit. <br /> /,�T�i�C G � C"'',��'L c��/� <br /> First Middle Last <br /> //7�' �/.n-� c����c� •�G t� <br /> Address <br /> �L������ ���,G� �s��� �� <br /> City State Zip <br /> ���-,���� <br /> Phone <br /> I understand my rights as stated above. <br /> / /-� ,� , 7 <br /> [�f�'�-t1- �-�1 �CQ 2' � '� <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />