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, ._., . . <br /> F_ -. ORONO <br /> ' . Minnesota 55323•Municipal Offices <br /> 'i.;,_]:'..' CITY. Post Office Box ss•Crystal Bay, <br /> OF- - <br /> s On the North Shore of Lake Minnetonka <br /> Z 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 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 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 /> other <br /> 3. The information <br /> may be the extenthnecessaryared hlocal , <br /> to process the permit or <br /> federal agencies t <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. `----D <br /> I� 6._ /� / <br /> r <br /> First Middle Last <br /> Address <br /> Nrg <br /> City State Zip <br /> 60_ ,-- 5-67 ,- r ,c-_ <br /> Phone <br /> I understand my rsg'hs as stated above. <br /> (/ -1:-.--, / . <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE —473-7358 <br /> • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />