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e, <br /> CITY of ORONO <br /> Post Office Box E 6•Crystal Bay,Minnesota 55323•Municipal Offices <br /> 0 <br /> e . On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISOR <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 confidenti 1 information. <br /> You are notified that: <br /> 1. The information you furnish will 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 information maybe <br /> ent necessashared 1 hother to processcal, state or <br /> the permit or <br /> federal agencies to the e <br /> license. <br /> 4. If. your requested permit or license requires Council 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 or <br /> permit. <br /> First Middle ast <br /> Address <br /> City State 3-P <br /> Phone <br /> I understand my rights as stated above <br /> Signature <br /> BUILDING&ZONING—473-7357 <br /> • ADMINISTRATION&FINANCE— 73-7358 • PUBLIC WORKS—473 7359 <br /> . ASSESSING <br />