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. � <br /> � <br /> CITY of ORON� <br /> Post O�ce Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <br /> • <br /> s - � � 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 /> license from the City of Orono or any of its departments may require <br /> you to furnish certain private or confidentia]. 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 /> federa]. agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Council. action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�e <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ��rc K 1Vy�j�cc � � (ErU (� <br /> First Middle Last - <br /> I 3c�1 N - J�r rh ��, <br /> Address <br /> � c3Ro�a �/� � S53L <br /> City State Zip <br /> �! 7 2 � ��l � z <br /> Phone <br /> 2 understand my rights as stated above. <br /> . � <br /> Signature . <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION�FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />