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- . � . <br /> � �O <br /> GI'T�' of OROI <br /> Post Office Box 66•Crystal Bay,Minnesota 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 /> 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 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 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 inf ormation �nay become public. <br /> 5. You have certain rights under M.S. 13.04 to review pricat� <br /> data on yourself. <br /> 6. Your full. name is required to process this applicatian or <br /> permit. <br /> �,�� cJ�IsT�� �a�C �ati1s j..G� . <br /> First Middle Last <br /> . 7 �y-� ��a��s �� � <br /> Address <br /> Q ���, S / <br /> Cit State Zip <br /> %a o -��'�l/ <br /> Phone <br /> I understand my rights as stated above. <br /> ignature <br /> BUtLDING&ZONING—473-7357 • aDMINiSTRATION&FtNANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING • <br />