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�`z { �, <br /> � n:,` �� 't`�`-_a y,;' <br /> � 1 <br /> f_ �a <br /> ` ��;��� � � x il C ITY of ORONO <br /> r � �� . <br /> � � .,�; <br /> i k i„:�,.+�. Y�.`h,��.�,,� . <br /> � ,� �. � Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> ,t <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 /> Iicense 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 license 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 , s`ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense reguires Council act�or. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full na:ne is required �o process this application or <br /> permit. <br /> ` � - ,= ,i,. , � f —�,. �� <br /> �c= - <br /> First Middle Last <br /> I . � �� �.� � _�� �r � >= �-�. <br /> Address <br /> r � � . � <br /> � , . _ - �c I e��_�� - - <br /> City State Zip <br /> , ,� � , , <br /> Phone <br /> I understand my ri�ghts as stated above. <br /> � <br /> _ LY�` � i <br /> �gnatur'e <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSI:VG <br />