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� <br /> . , <br /> �I'TY of OROIOTO <br /> Post Office Box Fi6•Crystal Bay,Minnesota 55323•Municipal Offices <br /> ! <br /> • � � v 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 Iicense 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 information may be shared with other local. s�ate or <br /> federal agencies to the extent necessary to process the permit ar <br /> Iicense. <br /> 4. If your requested permit or Iicense requires Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application ar <br /> permit. <br /> , � <br /> �� <br /> Fir t iddle Las <br /> f� � <br /> ���� C� ��� � <br /> Addr s ��� <br /> , <br /> eN- <br /> Cit State Zip <br /> '��� <br /> Phone <br /> I under nd ights as stated above. <br /> . � <br /> S g ur � • <br /> BUILDING&Z'�NING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473 7359 <br /> ASSESSING <br />