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: � . , <br /> "�� C� �'SY.:k:� <br /> �� a ����°,����� CITY of ORONO <br /> t�� <br /> ��zx ; �t���.: <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <br /> � - e � 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 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 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 Iicense requires Councii. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 �o review pri�a�e <br /> data on yourself. <br /> 6. Your full namP is required to process this appl.icatian or <br /> permit. <br /> —�.�„M-�s -� rc�,�� /v �,�TfC�51"l�.tc�-f- <br /> First Middle Last <br /> 3`1�� t_�i�, � �v <br /> Address <br /> i.,�t/ ,,✓uA7��� ,/� � .�S ��/ <br /> Cit � State Zip <br /> Y <br /> y7� - 7 � f�l <br /> Phone <br /> I understand my rights as stated above. <br /> • o , <br /> � <br /> Sign ure <br /> BUILDING&ZOMNG—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />