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M y � <br /> /�(+ , <br /> ,`' � . . ' <br /> � � . ����'�� ���.�T� <br /> Post Office Box 66•Crystal Bay,Minnesota Sa323•Municipa.l pffices <br /> 0 <br /> a - • 9 . On the North Shore of Lake li�finnetvnka <br /> DATA PRSV�iCY ADpISORY • <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 /> 3.icense �from the City of Orono or any of its departments may reguir� � <br /> you to furnish certain private or canfidential information. <br /> You are notified that: � � <br /> I. The information you furnish will be used to determine your <br /> qualification for the pet:nit or license re�uested. . <br /> - 2. You raay refuse to supply data, but r�=usa1 may require t�at <br /> the City deny the permit or license. - <br /> • 3. The information may be snared witn o�zer iocal, s�ate or <br /> ' federal. agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested per�it or Iicense r�cuires Counci3 ac�=on <br /> to approve, some inforacation may become �ub3ic. <br /> 5. You have certain rights under M.S. � 13.0? to rev_ew Friva�e <br /> data on yourself. _. <br /> , , 6. Your fu11 name is required to process th�is appZicatioa or <br /> penait. <br /> �- � �e..., ��,� o�J <br /> � First Midd�e Las� <br /> �� � o lcr �C<,� �� . <br /> Addre s <br /> i ����€���,�� ��'li�v�V� ��`"3 �f.� <br /> City State Zip <br /> �2 Z � �� � � <br /> Phone <br /> ' I unde*- tand my right as tated above. <br /> �' <br /> • Signa re , • � <br /> 1LDtYG& ZONIYG-473-7357 • ADtit1.y1STRATION&FIV 1NCE-473-73:3 • PUBLIC WORKS-473-7339 <br /> ASSESSiVG ' <br />