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r� - � <br /> ` � C���.' o� ���TiT� <br /> Post Office Box 66•Crystal Bay,Minaesota 55323•Municipal Offices <br /> � On the North Shore of Lake Mirr.netonka - <br /> • ' • • <br /> DATA PRIOACY ��SORY <br /> � "Rights of subjects of <br /> Subd. 2� ermit or <br /> 13.04, uest for a p <br /> In accordance with M.S• ou that your req uire <br /> data", we would like to inform Y of its departments may req <br /> Iicense from the City of Orono or any <br /> Y <br /> ou to furnish certain private or confidential information. <br /> You are notified that: � <br /> The inf ormation you f urnish i ensebrequested, aetermine your <br /> l. ez-.nit or 1 <br /> aualification for the p require that <br /> refuse to supply data, but refusal may <br /> 2, You �aY the permit or license. <br /> the City deny <br /> be shared with other local, s�ate or <br /> 3. The information may <br /> rocess the permit oi <br /> f ederal agencies to the extent necessary to p <br /> license. <br /> a f aur requested permit or license rhequC res Councii. a��'°r <br /> I Y become p <br /> to approve, some information may <br /> - You have certain rights under M.S. 13.04 to review private <br /> �. <br /> data on yourself. <br /> 6 , Your full name is required to p <br /> roc�ss this appl.ication or <br /> rmit. � <br /> � � <br /> � <br /> a l� ,�� o �i /'l Lzst <br /> First <br /> Midd , <br /> � l ^ <br /> Address � 3 <br /> � � <br /> �, L State Zip <br /> Ci�y <br /> ���� , . <br /> Phone <br /> I understand my rights as stated abone• <br />� <br />� � r • <br />� . • <br /> t . <br /> � Sign re <br /> . � PUBLIC WORKS-473-7359 <br /> gUILD[NG&ZONING-473-7357 • ADMINISTRATlON&FINANCE-473'7358 <br /> ASSESSING <br />