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�t .�"^���,; <br /> 7r� � <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 Iike to inform you that your request for a permit or <br /> I.icense 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 /> 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 /> 3icense. <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 priva�� <br /> data on yourself. <br /> 6. Y�,ur full name is required to process this applicatian o� <br /> permit. <br /> __ <br /> �-- _.. ,, __ .n <br /> � 1. � <br /> � � <br /> `� _��y� �,-,t,..,, � ���� c tf���,5� �--�--��c� <br /> First Middle Last <br /> _----,_-� — <br /> `_�� �.�. �A ,��-r�-RCLt= �r-� ti L. <br /> Address <br /> � 1��a.a,��1a �'l �, � _��� l <br /> City State Zip <br /> ,� -� � _ �, 7 �-� � <br /> Phone <br /> I und�/tand �my rights�s�tated above. <br /> , � <br /> � / <br /> S ' a r <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&F[NANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />