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F �� , ' . <br /> o '�.�'�� ��..`�, <� <br /> iF +4�7 � �3 C <br /> , <br /> 'i� a i <br /> �� t��`�'�f�� �� .� CITYof OR�NO <br /> � E y� <br /> � { �3��'k{ � �� �` Post Office Box 66•Crystal Ba Minnesota 55323•Munici al Offices <br /> >. ,y.,r " ,.��. ��r.,. Y� P <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 /> 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 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 Councii 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 /> ' � (� �� <br /> �`.�.�r���AC' •i � 1� �ll`flt.1E"� <br /> First Middle Last <br /> � � y. i <br /> 1 ° � �; i �� ' ,;;�� <br /> Address <br /> �"J r ��,��c� '���h� - <br /> City State Zip <br /> �..,� �..�, <br /> .� 1�a, <br /> Phone <br /> I understand my rights as stated above. <br /> .i ,, <br /> ��e � <br /> ;, ; <br /> � `, ,w�,u-e� <br /> Signature <br /> BUILDING&ZONING-473-7357 • ADMINISTRATIOIV&FINANCE-473-7358 • PUBLIC WORKS -473-7359 <br /> ASSESSING <br />