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���� <br /> F�� � CITY o� ORONO <br /> x�_ - .� <br /> Post Office Box 66•Crystal Bay, Minneaota 55323•Municipal Of�ices <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 /> Zicense 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 wil.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�a�� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> C��t-ifZ -�i�OP�-I�--- I�n1��Ic:F ��C�� <br /> First Middle Last <br /> �S��{- � �ICQ{(1 �`J� �" <br /> Address <br /> ��o,o\e p\a�� M,N 5��5�1 <br /> Ci� State Zip <br /> G1�q - �o�a <br /> Phone <br /> I understand my rights as stated above. <br /> �- <br /> Signature <br /> BUILDING& 7.ONING—473-7357 • AD!vtINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSIN G <br /> � <br />