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.. , <br /> r'� <br /> �,} <br /> �''�"' , �, 1� �, ,: <br /> �A , <br /> � ',.r�� .. � ci�TY O� OR�N� <br /> r� x. .+��,.: .. <br /> � � fI �1� <br /> �,� � Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> � �,,�� <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 confidentia3 information. <br /> You are notified that: <br /> 1. The information you furnish will 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 Iicense. <br /> 3. The information may be snared with other local , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or license requires Councii actior. <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 name is required �o process this application or <br /> permit. <br /> � � . <br /> First Middle Last <br /> � � <br /> �� �.4� <br /> Address <br /> � �� �� c 1 <br /> City State Zip <br /> �-� S - � `�C� � <br /> Phone <br /> I understand my rights as stated above. <br /> _ �-(,���/�l� <br /> gnatur <br /> BUILDING&ZONING—473-7357 • ADMINISTRATIOti&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />