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� <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <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 Iike 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 /> gualification for the permit or ].icense 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 /> license. <br /> 4. If your requested permit or license requires Council action � <br /> to approve, some information may become pub3.ic. <br /> 5. You have certain rights under M.S. 13.04 �o review priva�� <br /> data on yourself. <br /> 6. Yaur full namP is required to process this appl.icatian or <br /> permit. <br /> �o � �J o w�a.k, J a-.�-`s�es <br /> First iddle Last <br /> � -o L_e a �e�fi <br /> Address <br /> �.o L a�ke sS �S <br /> City State Zip <br /> �0( 2 - ���- 0 �36 <br /> Phone <br /> I un erstand rights as stated above. <br /> Signatur <br /> BUILD(NG&ZONING-473-7357 • ADMINISTRATION 3c FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />