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, . , � <br /> � � <br /> CI'�Y of-ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <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 wou3.d 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 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 refusa]. 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 priva�e <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> J A�•5 C.l�M) 1 �Fw �TT CpN7�f1G'Tb Q, o�'�C�GE� <br /> First Middl.e Last �„g��e GN✓lRONMWL� <br /> �.z29 Fi2���+DS►��� L� <br /> Address <br /> t3v M N Ss33 7 <br /> City State Zip <br /> R 44 38 Z3 <br /> Phone � <br /> I understand my rights as stated above. <br /> ure <br /> BUILDING&ZONiNG-473•7357 • ADMINISTRAT70N&EINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />