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1� <br /> - � . • . , . , , <br /> � <br /> CITY of ORONO <br /> Post Office Box 66•Cryatal Bay,Minneaota 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 suppl.y data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may be shared with other Zocal, state or <br /> federa]. agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or ].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 yourse].f. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> ..��?/3%��� /�• � I� v�' <br /> First Middle Last <br /> ��20 /110, e�✓'tdi2C-; �121 Vr <br /> Address <br /> ��l, Gi2o�v . ��3�� <br /> City - State Zip <br /> 4�7�-g��9 <br /> Phone <br /> I understand my rights as stated above. <br /> Signat r <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION bE FINANCE—473-7358 • PUBLIC WORKS—473-735� - <br /> ASSESSING : <br />