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. <br /> . <br /> ��� � <br /> � <br /> x <br /> s�z;�, �- -� "` <br /> �"� `�=�� ����� CITY of ORONO <br /> , <br /> ::.,_��:...,_r'. <br /> � ��� Post Office Box 66�Crystal Bay,Minnesota 55323•Municipal Offices <br /> :�wy <br /> 'e &,� � , <br /> `m�°_ � v 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 /> 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 local , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense requires Councii ac�ior. <br /> to approve, some information may become public. <br /> 5. 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 /> �J�i�k_S ��' '7 �Y `1?�1'`y�'c'�� <br /> First iddle Last <br /> `�7 Z 1���-��� �;� �� <br /> Address <br /> L��/��r� 1�,c.� S����I <br /> City State Z1p <br /> �7/ -�-�s <br /> Phone <br /> I understand my rights as stated above. <br /> � � L �� <br /> Signature ��� <br /> ',")� <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESS[NG <br />