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- s�., , � � <br /> n <br /> . � � <br /> C ITY of ORUN <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•MuniciPal Offices <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 confidentia3. information. <br /> You are notified that: <br /> 1. The information you furnish wi3.1 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 , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Council ac��or_ <br /> to approve, some information may become publ.ic. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ��fC�/��� � 6� . _�"'���� �JP <br /> Middle Last <br /> First <br /> S�� � ��'� /��' <�0 , — <br /> Address /1^ <br /> ��� f, <br /> � zip <br /> City State <br /> ��'- ��� <br /> P oh ne <br /> I underst nd my r' hts as stated above. <br /> � <br /> g atu • � <br /> BUILDING&ZONiNG—473-7357 <br /> • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />