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_ . � , . <br /> �� �r� <br /> �. <br /> `� t «-f� v: ' < <br /> � � � 1 <br /> .��� ' :�` �� C ITY of OR�i�� <br /> �: .��K- <br /> � � � �� ` Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> f <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 f rom 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 wil.l 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 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�e <br /> data on yourself. <br /> 6. Your ful.l name is required to process this applicatian or <br /> permit. <br /> � � iL� <br /> � � , '��. �J� � <br /> � <br /> First Mi dIe !' Last <br /> �� ��� ��' ���� , <br /> � <br /> Address <br /> f r �, � � �� l�� a` � <br /> City State Zip <br /> 6� � , 7 � <br /> Phone <br /> I derstand y ri ts as, tated above. <br /> Signature . <br /> BUILDING&ZOVItiG-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS -473-7359 <br /> �SSESSiti G <br />