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�f a <br /> � � <br /> CITY o� ORON� <br /> _ Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � . � � On the North Shore of Lake Minnetonka <br /> . . DATA PRNACY 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 /> 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 wi13. 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, 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 Councii action <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 to procsss this application or <br /> permit. <br /> CC �r � <br /> First Middle ast <br /> � � <br /> Address <br /> � ,�e /1�f� �-.�"3�� _ <br /> City State Zip <br /> ��� ��� ���� <br /> Phone <br /> I understa d my ri as stated above. <br /> C <br /> Si ature • <br /> BUILDING&ZONING—473-7357 • ADMINISTRATiON&FINANCE—473•7358 � PUBLIC WORKS—473-7359 <br /> ASSESSING <br />