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� � <br /> �.�W <br /> �� ��4s � <br /> ��� . +������. - <br /> y :w �I��' of O�O�TO <br /> `* , ,. �'�',�: A.: <br /> �, ���, � � , ; _ <br /> �''`�:'�"r:-��.. �� � `� <br /> ,�'. <br /> """� � Post Office Box 66•Crystal Bay,Minnesota 5a323•MuniciPal�� <br /> =:�-.: <br /> _. ,�;.; <br /> :��-t-� � � <br /> , `� _ o ��, On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2, "Rights of sub e�it or <br /> data", we would Iike to inform you that your request for a P uire <br /> license from the City of Orono or any of its departments may req <br /> you to furnish certain private or confidential information. <br /> You are 'notified that: <br /> 1. The information you fu�*nish will be used �to determine your <br /> qualification for the permit or Iicense requested. <br /> 2. You may refus'e to supply data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may �enthnecessaryhto processcthe p rmit or <br /> federal agencies to the ex <br /> license. <br /> 4. If your requested permit or Iicense requires Councii action <br /> to approve, some information may become public. <br /> 5, You have certain rights under M.S. 13.04 to review pricat� <br /> data on yourself. <br /> 6, yaur full name is required to process this applicatiaa or <br /> permit. <br /> /�-�.� � , ld-ol �1 <br /> First <br /> Middle Last <br /> b �J��.�, . . � A-�Y� <br /> .._--,.r <br /> . � <br /> Address <br /> �N� t�r�,� , �S^9' <br /> City State Z1p <br /> ���0'� �FJ�O <br /> Phone <br /> I understand my rights as stated above. <br /> S ' ure � <br /> BUILDING&ZONING-473-7357 • ADMINISTRATIO�I&F[NANCE-473-7358 <br /> • PUBLIC wORKS-473-7359 <br /> ASSESSING <br />