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CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minneeota 55323•Municipal Offic�s <br /> • <br /> � • � � On the North Shore of Lake Minneto�cka <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 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 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 3.oca1, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If yaur requested permit or license requires Council action <br /> to approve, some information may become public. <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 applicatian or <br /> permit. <br /> - �C��/L t� <br /> irst Midd <br /> Ie Last ���� <br /> '��� C��2�1^ 1�/'��J - <br /> Address <br /> �'��ti� !-��� ���� �� <br /> City State Zip <br /> S� Y - a�s � <br /> Phone <br /> I understand my rights as stated above. <br /> / ^ <br /> nature . <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION dk FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />