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f -r- <br /> � <br /> •n� � j+�`��,:,A <br /> •`�'I t�747"7 tfe 'tFi±'p.. <br /> :t4; <br /> ,�' a t.,.'� �� <br /> J� i%����'�' � CITY of ORONO <br /> A <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> � <br /> s _�� y �. On the North Shore of Lake Minnetonka <br /> d h��., � <br /> �,, #.�, <br /> , :,.�� <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2 , "Rights of subjects of <br /> data", we would 3.ike 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 wi3. 1 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 tha-t <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 /> license. <br /> 4. If your requested permit or Iicense requires Councii. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 �o review pri�a�� <br /> data on yourself. <br /> 6. Your full namP is required to process this application or <br /> permit. <br /> �.j�r�,AbO �,, ��� �o�. _ <br /> First Middle Last <br /> �Z� l'i T��L�� -1�`(Z-f'� �-- <br /> Address � <br /> ��r.� �1 I r-1� j <br /> C ' ty State Zip <br /> � � � �� � <br /> Phone <br /> I understand my rights as stated above. <br /> . ---._y <br /> Si a u e <br /> BUILDING&ZONING—473-7357 • ADMIN[STRATION&FINANCE —473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESS[NG <br />