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� � <br /> � <br /> CITY of ORONO <br /> Post Office Bo:66•Cryatal8ay.Minneaota 55323•Mnnicipal Offices <br /> • . <br /> � - � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. �3.04, 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 wil.l be used to determine your <br /> qualification for the permit or license 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 /> Iicense. <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�a <br /> data on yourself. <br /> 6. Yaur full name is required to process this applicatian or <br /> permit. <br /> {�� c��U�� � � � "L� <br /> �< <� ��� <br /> First �Middle Last <br /> I�'C� �f� ����'� �� <br /> Address - <br /> ��,�,��,��� ��� �.�3�y=�� � <br /> City State Zip <br /> �7� _ `� 7,5 � <br /> Phone <br /> I understand my rights as stated above. <br /> �, . <br /> �-.- �j �� � <br /> � � // �� I , � � ,� <br /> ��1�� / <br /> S'�.gna re , � <br /> � <br /> BUILDING 8c ZONING—473-7357 � ADMINISTRATION dk FINANCE—473-7358 • PUBLIC WORKS—473-7359 ! <br /> ASSESSING • I <br /> i <br /> i <br /> i <br />