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�� <br /> . `� <br /> � CITY of ORONO <br /> Post Office Box 66•Crystal Bay,�Vlinnesota 55323•Municipal Offices <br /> • <br /> s • � � 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 like to inform you that your request for a permit or <br /> I.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 /> l. The information you furnish wi1.I. 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 Council. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�atc <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ��� M��� C�,ac.��f/��r <br /> First Middle Last <br /> �C1 ���1"�'lCt t�L2 �!�'E����'I <br /> Address <br /> C�U�Iz�� J'`/��, �S;�r� i <br /> Cit� State Zip <br /> 4`��- C�:��-`� <br /> Phone <br /> I understand my rights as stated above. <br /> " ����;�1'1C��- �rf��'�����. <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />