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� � <br /> � <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � - � � 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 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 /> 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 Zocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Counci3. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�at� <br /> data on yourself. <br /> 6. Your ful.l name is required to process this appl.icatian or <br /> permit. <br /> �/��Y�.�� ,�C� :��/'� ��i�/1.�� <br /> First Middle Last <br /> /�i:J �,��r �-'/=L� ����_`� ��� ��d <br /> . <br /> Address <br /> �� � �.% �.� C.% �l� �� �_� <br /> City State zip <br /> .'J �� � ��`�� <br /> T� <br /> � <br /> Phone <br /> I understand my rights as stated above. � <br /> �— � , _.. <br /> , <br /> :----- � .., <br /> , %�--� ��� J��- - <br /> S�gn re . <br /> � �. <br /> �. <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />