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� <br /> C ITY of ORONO <br /> Post Office Box 66•Cryatal Bay,Minneaota 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 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 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 Iocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or 3icense requires Counci3 action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�c <br /> data on yoursel.f. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> -��A��D �:�rl�,� -�t��7`f�!G ld <br /> First Middle Last <br /> �,..' � L�.�i n»FI � � ) � <br /> Address <br /> ��,�- �.�._. �-s-�� _ <br /> �lty State Zip <br /> �� -�/b�3 <br /> Phone <br /> I understand my ights as tated above. <br /> �_ <br /> Si nature � <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING - <br />