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���Y.F�� �.' <br /> � v Li�'��' O� ���1�'� <br /> �:.�;� <br /> .�. <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <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 /> 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 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 /> Iicense. <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 prica�� <br /> data on yoursel.f. <br /> 6. Your full. name is required to process this application or <br /> permit. <br /> /Lud1 ��/L.E- C ��.J <br /> First Mid le Last <br /> �0- /��,� s'�3 <br /> Address <br /> LU/�Y��� i"/�,cJ.cC;S��%7� `i� 3<</ <br /> City State Zip <br /> g j� ¢��' � , <br /> Phone <br /> I understand my rights as stated above. <br /> �-- <br /> Signature <br /> BUiLDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />