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r I <br /> _ _ \\_. <br /> . <br /> _ A..._ <br /> _ = _ <br /> CITY of ORONO <br /> CITY`- Post Office Box 66.Crystal Bay,Minnesota 55323•Municipal Offices <br /> QF <br /> ORONO 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 Cityf 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 <br /> 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 may be shared with other local, state or <br /> federal agencies tO the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Council action <br /> to approve, some i#Iformation 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 /> tays T e16e, <br /> First r Middle �ast dew - <br /> 2 • 5 Coon side. 335 335 . d s 11 Q�. <br /> Address <br /> Baud <br /> Leen Lae- ak.n 5535G. <br /> 4 <br /> City State Zip <br /> 4-76 - Dg52- <br /> Phone <br /> I understand my rights as stated above. <br /> nfrA-er) ( .4....i4) ar,t,"'-- <br /> Signatur <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />