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.. t . _ , <br /> . � <br /> �- t <br /> � <br /> � <br /> � CITY of O ONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � - � � On the North Shore of Lake Minn.etonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subj cts of <br /> data", we would like to inform you that your request for a pe mit or <br /> license from the City of Orono or any of its departments may r quire <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The information you furnish wil.l be used to determin your <br /> qualification for the permit or Iicense reguested. <br /> 2. You may refuse to supply data, but refusal may requir that <br /> the City deny the permit or license. <br /> 3. The information may be shared with other local, s� te or <br /> federal agencies to the extent necessary to process the pe it or <br /> Iicense. <br /> . 4. If your requested permit or 3.icense requires Council c��on <br /> " to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pr ' vate <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> �O�-1� 1r1 � Fav �ES <br /> First Middle Last <br /> S2S S • Q,��. S� <br /> Address <br /> (�nP�.S �� SS'-�oy <br /> City State" Zip <br /> 332-� ?281 <br /> Phone <br /> 2 understand my rights as stated above. <br /> � �- ��_:�a . <br /> Signatur <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS 473-7359 <br /> ASSESSING <br />