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. <br /> � <br /> � <br /> - CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offtces <br /> 0 <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 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 will be used to determine your <br /> qualification for the permit or license 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 local, s�ate or <br /> federal agencies to the extent necessary to process the permit ar <br /> license. <br /> 4. If your requested permit or Iicense requires Councii act=on <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ��1���-`-� ����5 Wt �s o� <br /> First Middle Last <br /> �s� �������� <br /> Address <br /> �D��LI V ' ��N � � �v C 1 � _ <br /> City State Zip <br /> � ,/ �— ��7 � <br /> Phone <br /> I unders and my rights as stated above. <br /> Sig ature . <br /> BUILDIIVG&ZONING—473-7357 • ADb11NISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473•7359 <br /> ASSESSING <br />