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� <br /> "'�' _ .� <br /> , ,� � <br /> r k z� ��� � ;� CITY o� ORONO <br /> � �� � <br /> , }Y' �4��"�hx : <br /> � `� � � �� ' Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> ;�, ;�,..�. :� <br /> • <br /> � _ � a 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 /> 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 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 /> Iicense. <br /> 4. If your requested permit or Iicense requires Councii. actian <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> E. Your ful.I name is required to process this apFlicatian or <br /> permit. <br /> �L;`�'L �/�`�� `������� y� <br /> First -" Middle Last <br /> , <br /> l� �l .5�i ✓�'�� �r��- - <br /> Address <br /> �� Z��, ,e�/�' `� �����1�� <br /> Ci y State Zlp <br /> � <br /> , � C"" '� <br /> Pho e � <br /> I understand my rights as stated above. <br /> Si n e <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />