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+-i ' <br /> � - NO <br /> �ITY of ORO <br /> Post Office Box 66•Crystal Bay, Minnesota 55323'MuniciP� ��� <br /> • <br /> � _ � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY 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 /> Iicense f rom 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 yoe�fi�or Zi ensebrequested, determine your <br /> qualification for the p <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 oth�ocesscthe permit or <br /> federal agencies to the extent necessary to p <br /> license. <br /> 4. If your requested permit or license requires Council ac��or. <br /> to approve, some information may become public. <br /> 7. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6 . Your full name is required to process this application or <br /> permit. <br /> ����� !/� ;'�r`-��C.j/ �l �l.J+�.J��"\ <br /> � � �--� - <br /> First <br /> Middle Last <br /> ���C- i_��,`(., � � � <br /> Address _ <br /> � � �_ > � ,� ,� <br /> �� `-.. <br /> t� �r�-��-��7���'�-- <br /> City State Zip <br /> �;J �. �- j�; <,/ �- <br /> Phone <br /> I understand my rights as stated above. <br /> � <br /> 7 � j� `/''/ <br /> . '��/ L..,-�'� >' /.�-LT-i! ,���.. <br /> i <br /> Signature <br /> B[JILDING& ZONING-473-7357 • ADMINISTRATION&F[NANCE-473-7358 <br /> • PUBLIC�4'ORKS-473-7359 <br /> ASSESSIN G <br />