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� <br /> CI�`� o;� ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> e • � � 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 snared with other Iocal , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Council act?on <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6. Your full name is required �o process th�is application or <br /> permit. <br /> �VA�"-���( '1' ��N,��1/1/ <br /> First Middle Last <br /> I!7 al I � i 1,w a-- �, <br /> Address <br /> ����,�.-� �. fV S �3 �` <br /> City State Zip <br /> c�1S2 -- �� � — ii�.Z <br /> Phone <br /> I d m rights as stated above. <br /> � <br /> Si n t <br /> BUILDING&ZONING -473•7357 • ADMINISTRATION&FINANCE-473•7358 • PUBLIC WORKS -473-7359 <br /> ASSESSiNG <br />