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.� ' <br /> • � �� 1 �v:;, <br /> ��� « <br /> y``��� �� � CITY of OR�JN� <br /> - �� ;Ff G�4w�'•�n^ <br /> �.��,{��:�� <br /> � g`At'.?�.. � ' . <br /> �-.t ii. <br /> Post O�ce Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � _ � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> %� <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 /> 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 I.oca� , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If youz requested permit or Iicense requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priLa�� <br /> data on yourself. <br /> 6. Your fu3l name is required to process this applicaticn or <br /> permit. <br /> ��,,�..v,�, �,,,5-4-�,,�,�.�.�-, � . �- - . <br /> �,.�'.�� � <br /> �$ �� .-�-�- <br /> Fi st Middle Last <br /> y`-i r.•� � r"-c�4'...r--� �� - <br /> Address <br /> -�y� 4� --�,� , �3� � <br /> � <br /> City State Zlp <br /> � -7 `� - C�' �'`E� <br /> phone <br /> � <br /> I under d my rights �.s sta ed above. <br /> ; <br /> . ,>%y�, <br /> Signa � re � <br /> BUILDING'&ZONING— 473-7357 <br /> • AD'�iItiISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSIN G <br />