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.. , <br /> . , . . <br /> � <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <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 /> l.icense from the City of Orono or any of its departments may require <br /> you to furnish certain private or confidentiaZ information. <br /> You are notified that: <br /> l. 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 Iicense 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�� <br /> data on yourself. <br /> 6. Yaur ful3. name is required to process this appl.icatian or <br /> �t �- <br /> permit. / R t- C� /� �ri �a/P ,e .� .� 'UC. <br /> �o� h- � �v i.►� /V! �� e �- <br /> Fi t Middle Last <br /> 23 5^p r7s- �k �.� �V e � - <br /> Address <br /> �.4� c � � /�I � sr 5�3 v 3 <br /> City State Zip <br /> �.�.3 " �� 1- -�_'_' <br /> Phone <br /> I understand my rights as stated above. <br /> �.� . <br /> Signat e <br /> BUILDING&ZONING-473-7357 • ADMIlVISTRATION&FINAIVCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br /> I <br />