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- ,.. . <br /> �� <br /> , � �.r <br /> � ��`���� CITY of ORONO <br /> h t pyt�« <br /> ix � ; ��s <br /> � ` s' , <br /> a � ,„ <br /> y 1 ,y„��, 't.i z;; <br /> �-� �.� ,,�-.,:;.:-,, Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <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 woul� Iike 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 wil.l 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 local , 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. Y�ur full name is required to process this applicatian o� <br /> permit. <br /> �� ���..� �,�� ., ,,_ <br /> ' '-l� i , ' � ���L� .� L l <br /> First Middle Last <br /> �--�� � � ,(: ,.°�t_ ��� <br /> Address <br /> l��C Y-�r�� ��.� I l.l/�,,�` -:>> <br /> � ` <br /> City State Z1p <br /> �_�7-� >i ��-� <br /> Phone <br /> I unde�stand my rights as stated above. <br /> , <br /> �-- <br /> /� / � !/ <br /> , �. ��� - �_ <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&.FIrANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />