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. � <br /> � �' ��� � <br /> �� ',� ;,x <br /> � �� : CITY Of OI�011\T� <br /> � � <br /> 1� <br /> .h .- t <br /> ��'� � �-� :s Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> �` '``���::�� <br /> ;;�'�E•a,,.ii� � <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 confidentia3 information. <br /> You are notified that: <br /> l. The information you furnish wi3.]. 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 Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�at� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> �v v/�4<'� � � �/v�� y - <br /> First Middle Last <br /> /4�E%C c.V �'t T�c'�} /3 C,v� <br /> Address <br /> 1,��4-�-z.�i�- ,r-� ,.� 5 _� '� / <br /> City State Zip <br /> �f � S - ��-�f`�> C� <br /> Phone <br /> I understand my rights as sta`ted above. <br /> � %�� -. <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADM[NISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />