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� <br /> CITY of ORONO <br /> Post Office Bog 66•Cryatal Bay,Minneaota Sb323•Mnnicipal Officea <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 /> 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 wiZl be used to determine your <br /> qualification for the permit or license 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 infarmation may be shared with other 3.ocal, state or <br /> federal agencies to the extent necessary to grocess the permit or <br /> license. <br /> 4. If your requested permit or license requires Counci3. 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 yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> , � <br /> � . �a u <br /> First i d e Last <br /> 7 r � <br /> Ad ress <br /> � O <br /> City State Zip <br /> � 3-I� <br /> Phone <br /> I unders my rights as s te bov . <br /> Sign t e <br /> BUILDING&ZOIYING—473-7357 • ADMINISTRATION 8c FINANCE—473-7358 PUBLIC WORKS—473-7359 <br /> ASSESSING <br />