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. � <br /> CITY of 4RON0 <br /> Post Office Box 66•Cryatal Bay,Minneaota 55323•Municipal Officee <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 /> 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 Iicense. <br /> 3. The information may be shared with other �ocal, 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 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. Yaur full name is required to process this applicatian or <br /> permit. <br /> �',t,�-�eo-z� ���L/h � �/`f 6�-r� <br /> First � Middl.e Last <br /> 8� `�� �7r�� �r,.s �-v� �b. <br /> Address <br /> ��a s� � :n 9 7�, h1/lJ� ��`��--� <br /> City State Zip <br /> � �!- �� 9v <br /> Phone <br /> I unde tand my rights as stated above. <br /> Sign re . <br /> BUILDING&ZONiNG-473-7357 • ADMIN[STRATION&EINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />