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� <br /> . <br /> � I <br /> CITY of OI�ONt� <br /> Post Office Box 66•Crystal BaY,Minnesota 5a323•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 inf nr fo ltheypermit or I.i ensebrequested. determine your <br /> qualificatio <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 /> license. <br /> 4. If your requested permit or Iicense requires Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> � . <br /> First <br /> Middle Last <br /> I��$� �u� ���',Q,�SI�rL ��V 1�. <br /> Address <br /> �,,,�� ��or� l`���I� ��331 <br /> ,� ..�., �. <br /> City State Zlp <br /> �7y' �� � - <br /> P:�one <br /> I understand my rights as stated above. <br /> J <br /> Si natur <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473•7358 <br /> • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />