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�i+<e 'A�6 <br /> �I.: <br /> 'n��fi CITY of ORONO <br /> ,z. . <br /> �. <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Officea <br /> • <br /> � - � � 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 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 license requires Counci3: action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�L <br /> data on yourself. <br /> 6. Yc,ur full name is required to process this applicatian or <br /> permit. <br /> �✓�N -- �`� .�,. .�`. <br /> ��First Middle Las <br /> �-- ;:�. <br /> �� �� � .✓ / i `-( <br /> Address <br /> ,-�.. �, <br /> %.//��' ,��J /� A �,� _. ,1 i � <br /> City State Zip <br /> �� ./,�. j()� .�-- <br /> Phone <br /> I understand my rights as stated above. <br /> `� � / <br /> Si ature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />