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s . <br /> � <br /> C ITY o� OIiONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> 0 <br /> � . � e 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 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 wil.l be used to determine your <br /> qualification for the permit or Iicense 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, s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your reguested permit or Iicense requires Council ac��on <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your ful.I name is required to process this application or <br /> permit. <br /> lZorf�l �R-c�� lG l�C� <br /> First Middl.e Last <br /> ��E�� �«G�� L.�e�� <br /> Address <br /> ��c9,r�D D���l 55��� _ <br /> City State Zip <br /> �����r/I <br /> Phone <br /> � un rstand i ts stated above. <br /> � <br /> f <br /> , <br /> � <br /> �gn ure . <br /> BUILDING&ZONING—473•7357 • AD ATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />