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� �'i �,b J�� <br /> "�,y - � >d'�.�� !t� <br /> 1 � <br /> 5�' ia�� �� �`� � � C ITY of ORON� <br /> � <br /> . � <br /> a�.. �����.� �,,.: <br /> �'�'�,i Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> } �;`, � <br /> � On the North Shore of Lake Minnetonka <br /> 8 <br /> � • .e. <br /> ^� <br /> ,, <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of <br /> data", we would like 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 wi3. 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 ar 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 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 namP is req�iired to process this apt•Iicatian or <br /> permit. <br /> ' � � � ,��'r ��r� . <br /> First idd e Last <br /> %3�% r� �c. . <br /> Address � <br /> �� G��� ' S��3S <br /> City State Zip <br /> �=r3�-��n�� <br /> Phone <br /> I u rstand my rights as s ated above. <br /> � ' <br /> �? ��� �� , ,� r <br /> Si a�ture <br /> ,' <br /> BUILDING&ZONING—473-7357 • ADbiL'YISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />