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� <br /> CITY of ORO�TO <br /> Post Offioe Box 66•Cryatal Bay,Minneeota 55323•Municipal Offices <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 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 inf ormation you f urni sh wi 3.1 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 1.ocal, 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, 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. Yaur full name is required to process this application or <br /> permit. <br /> �Ll.i l4 OG � <br /> irst Middle Last <br /> 1�-G��1 �, , i4�vv� ,� <br /> Address '� <br /> oM,o urv� 1til,ti 5 5`3_b� <br /> City State Zip <br /> ���- �-3 7/ <br /> Phone <br /> I understand my rights as stated above. <br /> , g ure , <br /> BUILDING 8c ZONING—473-7357 • ADMIIVISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> • ASSESSING - <br />