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i "' <br /> ,� � <br /> .�� .�.�,r.a*�*y,"*y: <br /> ���` � ,_,�.,�-. <br /> ,i� .v.E:i '�. ---�.+,�_ <br /> � � ��'�� ��;�� CITY o� ORONO <br /> '� '�i' n���`"Jk'�4'�s'� <br /> ,x..4":�.^�..:t` ,��,��'.:.�.f`"';�.� <br /> .;dsffii':Eis:.-�, • ,+a'S"n:.�Li.sx` <br /> ��:^ ��"�-�`-�'� Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> t. <br /> r <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 /> 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 /> l. 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 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 privat� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> / � <br /> � ����,. ��i. ���C._ il i� � � � � <br /> First iddle Last <br /> v <br /> _5� � � /�/G hl ��N'�L <br /> Address <br /> �U0J% �/�Ef/= �"/.(J �S 3�(, <br /> City State Zip <br /> y �3 — ��� c�� <br /> Phone <br /> I understand my rights as stated above. <br /> � <br /> �s � <br /> \ � L <br /> �1.� `/'L"-'-'�'�.. <br /> Signature <br /> BUILDING&ZOIYING—473-7357 • ADMINISTRATIOtV&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br /> I <br />