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, - A► . <br /> � <br /> CI7C�' of ORON� <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Qffices <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 would like to inform you that your request for a permit or <br /> Iicense f rom 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 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 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 Counci3. action <br /> to approve, soine information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review prica�� <br /> data on yourself. <br /> 6. Yaur full name is required to process this ap�licatian or <br /> permit. <br /> /' ���I�,IS <br /> irst Middle Last <br /> � � � <br /> Address <br /> � 6 <br /> City State Zip <br /> �!o?�� <br /> Phone <br /> I u erstand my rights as stated above. <br /> , <br /> � <br /> - � <br /> ignature � <br /> BUILDING&ZONING—473-7357 � ADMINISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />