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� � � <br /> � <br /> �I'�"Y O� O�iON� <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> i <br /> - � ' � a 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 />, <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your <br /> qualification for the permit or license 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, s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Councii act�on <br /> to approve, some information may become public. <br /> �. 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 /> -'�'� a[o� �C� <br /> First Middl L st <br /> q� (�► l,a.�� <br /> Address <br /> �r�a ,� �53�C.� <br /> City State Z1p <br /> ��I �q g�b <br /> Phone <br /> I erstan my rights as stated above. <br /> Signa e �• <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—�i73-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />