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. , .., . <br /> � <br /> CI�'Y of ORUNO <br /> Post Office Box 66•Crystal Bay.Minnesota 55323•Municipsl Offices <br /> .._ . <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 /> license from the City of Orono or any of its departments may_require <br /> you to furnish certain private or _confidential =information. ,,,r._ ,,v�.:s, . : _ <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your <br /> qualification for the permit or license request�d.' <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 Iocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or 3.icense requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> �u�� �( S�o r�I— G-�►- (�S <br /> First Middle Last <br /> � o � �u' � S�s� <br /> Address <br /> .��i��+ �� �I�--� ��.� `� � <br /> City • . . State : Zip <br /> �7��� ��� ' "� <br /> Phone � � <br /> I understand m ts as stated . _ . _ <br /> _ _._ ,:� _ <br /> , L'/� ; <br /> at _ - � , <br /> BUILDING&ZONING—473-7357 • ADMINISTRAITON dk FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING , . <br /> ( <br />