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.� <br /> '{ CITY of ORONO <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 /> ].icense from the City of Orono or any of its departments may require <br /> you -to £urnish 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 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 ander M.S. 13.04 to revzew pri�at� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> � � �� , U ✓1 ��j; ; <br /> �- � <br /> First Middle Last <br /> � <br /> Address <br /> �� �� <br /> City State Zip <br /> _ ��+� <br /> � <br /> Phone <br /> I und stand my ights as stated above. <br /> S ' n tu e <br /> BUILDING&ZOIYING—473-7357 • ADMI[YISTRATION 8c FINANCE—473-7358 • PIJBLIC WORKS —473-7359 <br /> ASSESSING <br />