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• � e . <br /> a � <br /> �� F3 v:� � <br /> � �, � <br /> � � �.� � <br /> � c; �` � : CITY of ORONO <br /> � �;;�. �� . <br /> '� "� Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Offices <br /> �,- <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 Iike to inform you that your request for a permit or <br /> Iicense 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 wi].l be used to determine your <br /> qualification for the permit or license requested. <br /> 2. You may refuse to suppl.y data, but refusal may require that <br /> the City deny the permit or Iicense. <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 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 pri�a�� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> �zu�� � ����r���.I�i {�-Y ����- � ���.�� -- <br /> First Middle Last <br /> ' �% L' L��r.�; Lca`�{ t�71U C\ � <br /> A—dc�. ress <br /> ]_�_��,�,�_, l.-c-� ��c__ J'�`��V� � `7 � _Z��� - <br /> City State Zip <br /> �`{ �4/1�l -- z �l�� �� �`�� ' _=�`i =�-- -7� i �� <br /> Phone <br /> I und rstand my �ights as stated above. <br /> ,. <br /> i <br /> � _ �' �' ,..r-- . <br /> _�--' . t .L,; ____ <br /> Sigriature . <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING . <br />