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� <br /> CITY of ORON� <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <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 /> Zicense 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 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 iocal, state or <br /> federa]. agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Counci3. action <br /> to approve, some information 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 full name is e uired to process this applicatian or <br /> permit. <br /> � � - 1 � K.�. <br /> � b � <br /> First dd3.e ast <br /> � �o�Ua.r �-� • <br /> - o <br /> '�- • � <br /> A dress <br /> � � � _ � <br /> City tate Z <br /> � q \� a� a�b`� j��b-���� <br /> ( p � �� <br /> Phone <br /> I understand my t as ted ve. <br /> , <br /> Signatur , <br /> BUILDING&ZONING—473-7357 • ADMIIVISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING ° <br />