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� � <br /> � <br /> C�TY o� URONO <br /> Post O�ce Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <br /> � � � � On the North Shore of Lake Minneto�cka <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 af 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 license 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 local, s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Councii ac��or. <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 /> � . �� <br /> First Middle Last <br /> o s d <br /> Address ) <br /> � � ��� � <br /> City State Zip <br /> -���� �� ��� <br /> Phone <br /> I understand my rights as stated above. <br /> S� a ure � <br /> BUILDING&ZONING-473-7357 • ADMINISTRATIOIV&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />