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, <br /> � <br /> CITY of ORONO <br /> Post Ofhce Box 66•Crystal Bay,Minnesota 55323•Mwucipal Offiices <br /> • <br /> � - � � 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 /> 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 Iicense requested. <br /> 2. You may refuse to supply data, but refusa]. may require that <br /> the City deny the permit or 3icense. <br /> 3. The information may be shared with other i.ocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or 3.icense requires Counci3 action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> � ��r�t -e <br /> First Middle Last <br /> �� I'�- ,� G� <br /> Address —� <br /> � G�-�r z � , <br /> Cit� State Zip <br /> �f71 - �5 � � <br /> Phone <br /> I understand my ri h as stated above. <br /> Sign <br /> BUILDING 8c ZONING—473-7357 • ADMINISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING ' <br />