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� <br /> � <br /> � CI7��' of ORON� <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 Iike 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 /> l. The information you furnish will be used to determine your <br /> qualification for the permit or Iicense 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 license requires Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review prica�� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> �lb�� �/I� ` `' �-�`� <br /> First Middle Last <br /> �75�� � ����� �-� � <br /> Address <br /> ��' ��' ,�SS`�� <br /> City State Zip <br /> 91� ., ��� ` ��C�� - <br /> P�one <br /> I under tand my rights as stated above. <br /> , <br /> Signatu e � <br /> BUILDING&ZONING—473-7357 • ADMINISTRAITON�FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />