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f ORONO <br /> - C <br /> _ _ _ So <br /> =-„,... : <br /> -- Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> -CIS; = On the North Shore of Lake Minnetonka <br /> - _- DATA PRSVACY A02SCRY <br /> "Rights of subjects of <br /> Subd. 2, permit or <br /> In ' accordance with M.S. 13. 'that your request for a <br /> data", we would like to inform you of its departments may require <br /> license from the City of Orono or any <br /> you <br /> to furnish certain private or confidential information. <br /> You are notified that: <br /> information you furnish will be used to determine your <br /> 1. <br /> q The 3 permit or license requested. <br /> qualification for the p uire that <br /> City deny refuse to supply data, but refusal may req <br /> 2. You maythe permit or license. <br /> the <br /> with other local , state or <br /> be shared rocess the permit or <br /> federal agencies to the extent necessary to p <br /> license. aC`i or_ <br /> permit or license reauireS Council <br /> 4. If your reques,.�p.-d <br /> some information may become public. <br /> to approve, ; va�e <br /> 5. <br /> You have certain rights under M.S. 13.04 to review pr- <br /> data on yourself. <br /> 6. Your full name is required to process <br /> this application or <br /> permit. <br /> gop/xE/�/ L -1 MANNfef�' <br /> " L :. <br /> Middle as <br /> First � ��v 7793irO 0L- A c/e)15-7 B Y / <br /> Address M 5.5-3 j-� <br /> ���NO State Zip <br /> City <br /> q---73 -c 44.6-/ <br /> Phone <br /> I understand my rights as stated above. <br /> i S ' • at e • <br /> • ADMINISTRATION&FINANCE-473-7358 <br /> • PUBLIC WORKS-473-7359 <br /> BUILDING&ZONING-473-7357 <br /> ASSESSING <br />