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T � <br /> t <br /> � <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Offices <br /> • <br /> � • • s 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 like 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 /> qua3.ification 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 license requires Council action <br /> to approve, some information may become pub].ic. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your ful3. name is required to process this application or <br /> permit. <br /> �o1,r, V� �-e.�n r i cJ� <br /> First Middle Last <br /> I 5 o a <br /> Address <br /> ���� Y�'1 l� �"5 3� � <br /> City State Zip <br /> ��2- -��'6 5 <br /> Phone <br /> I understand my rights as stated above. <br /> ,� f . <br /> <.�/ <br /> S ' a ure <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINA[VCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />