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"'° : � - <br /> � � <br /> �.� ��`��� ti:, <br /> , -� <br /> �� ` �� �` �� CITY o� ORONO <br /> _ �� ��� <br /> �� <br /> 4 4����t�K�v <br /> `� f� � "'��`°' Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <br /> ! <br /> � - � � On the North Slzore 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 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 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 Counci3. action <br /> to approve, some inf ormation may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Yaur ful.l name is required to process this applicatian or <br /> permit. <br /> C�iG3/r��f=/� � ,/� c� y/��.�' _ <br /> First Middle Last <br /> -, � <br /> „ ��Ci .�%�/_1- �j� C;��- <br /> Address <br /> :� �, <br /> � �-t`>,C>%U/� /�//t/�i v :,� ,�� ` - <br /> City State Zip <br /> /�%���- �i// <br /> Phone <br /> I understand my rights as stated above. <br /> �.�UZ-e�� ( l '��� < ��1�� _ <br /> Signature . <br /> BUILDING&ZONING—473-7357 � ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />