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12/06/94 12:30• THE CITY OF ORONO 612-473-7357 003 <br /> CITY <br /> of ORONO <br /> CITY Post Office Box 66•Cristal Bay,Minnesota 55323•Municipal Offices <br /> OF On the North Shore of Lake Minnetonka <br /> OFIQNb <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2, "Rights of subjects of <br /> request for a permit or <br /> data",, we would like to inform you that yourq <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 furnishlicensewill <br /> be eeuused <br /> to determine your <br /> qualification for the permit <br /> supply or data, but refusal may require that <br /> the City deny the p <br /> 2. You may refuse e>� or�license . <br /> state <br /> 3. The information may be shared with other local , permit or <br /> federal agencies to the extent necessary to process <br /> license. <br /> permit or license requires council action <br /> 4. If your requested <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 /> M Run uist <br /> LO <br /> First Middle Last <br /> l�. 0. Box 383 279 North Medina St. <br /> Address <br /> MN 55357 <br /> Loretto <br /> City State Zlp <br /> (612) 479-1961 <br /> Phone <br /> I understand my rights as stated above. <br /> c / <br /> 3 ature f • <br /> BUILDING do ZONING-473.7357 <br /> • ADMINISTRATION dr.FINANCE-473.7358 a PUBLIC WORKS-473.7359 <br /> ASSESSING <br />