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CITY ®f ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55=•Municipal Offices <br /> On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> Subd. 2, "Rights of subjects of <br /> ou that your request for a permit <br /> we woul <br /> Indnlike to i formOro3y0 or <br /> require <br /> O data", f no or any of its departments may <br /> license from the City private or confidential information. <br /> you to furnish certain p <br /> You are notified that: - <br /> 1. The information you furnish will be uuested, determine your <br /> qualification for the permit or .license req <br /> - data, but refusal may require that <br /> 2. You may refuse emit ozllicense. <br /> the City deny the p <br /> be shared with other local, state or <br /> 3. The information may to process the permit or <br /> federal agencies to the extent necessary <br /> license. <br /> a If our requested permit or license requires Council action <br /> Y become public. <br /> to approve, some information maY <br /> S. You have certain rig <br /> hts under M.S. 13.04 to nevi ew private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> First <br /> Middle <br /> Last <br /> �7 <br /> Address <br /> City <br /> State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> Si u <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 <br /> • PUBLIC WORKS-473 7359 <br /> ASSESSING <br />