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• •� <br /> ��if�LM3 <br /> � �_C. <br /> � �� �Ar'� CITY of ORONO <br /> �. <br /> � �� <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � _ � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY 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 wil.l 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 iocal , 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 Councii action <br /> to approve, some information may become pub3ic. <br /> 5. You have certain rights under M.S. 13.04 �o review pri�at� <br /> data on yourself. <br /> 6. Your full name is required to process this apFlication or <br /> permit. <br /> �� � _ , � <br /> (�� ���;� t- �i�I� �_ <, ,'� t � �� � _ <br /> First Middle Last <br /> � ��i 1 �� � , ,�� � � � -� _ <br /> Address <br /> �• <br /> , )�) - ) l� (��� � ��� �� d� � � � ��� � � _� 5� S <br /> City ^� State Zip <br /> ���� ? -�� �' <br /> Phone <br /> I understand ,my�'�ts as stated above. <br /> , � ;; / <br /> r : <br /> / 1��, ,C L-C i�-'��---�.. <br /> Sig ature <br /> BUILDING&ZON[NG-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBL[C WORKS-473-7359 <br /> ASSESSING <br />