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CITy of ORONO <br /> Post Office Box 66•Crystal By,Minnesota 55323•Municipal Offices <br /> On the North shore of Lake Minnetonka <br /> DATA Pg MCY ADVISORY <br /> "Rights of subjects of <br /> 13.04, <br /> Subd. 2, permit or <br /> in accordance with M.S• you that your request for a P uire <br /> data", we would like to inform Y of its departments may req <br /> license from the City of Orono or any <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> The information you furnish i ensell brequesteused d. deteanine Your <br /> 1- emit or 1 <br /> qualification for the p require that <br /> 2. refuse to supply data, but refusal may <br /> the City deny You may the permit or license. <br /> t <br /> be shared with other local, sate or <br /> 3. The information may <br /> Process the pert or <br /> federal agencies to the extent necessary to p <br /> license. <br /> 4, If your requested permit or license a ublic <br /> to approve, res Council acti°n <br /> some information may be M.S. 13.04 to review private} <br /> - You have certain rights under e <br /> data on yourself. <br /> 6. <br /> Your full name is required to process this application or <br /> permit. _ <br /> Last <br /> First <br /> Middle <br /> Addre� 3� <br /> State Zip <br /> City <br /> Phone <br /> I understand my rights as stated above. <br /> b <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> PUBLIC WORKS—473 7359 <br /> • <br /> ASSESSING <br />