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, <br /> �' _ <br /> � <br /> C ITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <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 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 confidential information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your <br /> qualification for �he permit �r �.1CAI'!S@ 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 /> Iicense. <br /> 4. If your requested permit or Iicense requires Counci� action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�L <br /> data on yourself. <br /> 6. Your full namP is required to process this application or <br /> permit. <br /> ��Zl°��'d�1 Q pJ �G'vlG�%J��t <br /> First Mi dle Last <br /> s3�3 � � �� . <br /> Address <br /> � �1��/ �-� <br /> City State Zip <br /> SZZ 7 5 7�/ <br /> hone ,�/I <br /> �' �3s �T���f2�"� /Ppa� <br /> I understand my rights as stated above. - <br /> Signatur <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FIN�+u�ICE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />