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CITY of ORONO <br /> CITY Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> OF <br /> .ORONO On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accor• ance 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 he City of Orono or any of its departments may require <br /> you to furnis certain private or confidential information. <br /> You are otified that: <br /> 1. The ' nformatiori you furnish will be used to determine your <br /> qualific-tion for the permit or license requested. <br /> 2. You m- y refuse to supply data, but refusal may require that <br /> the City •eny the permit or license. • <br /> 3. The nformation may be shared with other local, state or <br /> federal a encies to the extent necessary to process the permit or <br /> license. <br /> 4. If yc}ur requested permit or license requires Council action <br /> to approve, some information may become public. <br /> 5. You h ve certain rights under M.S. 13.04 to review private <br /> data on y urself. <br /> 6. Your ull name is required to process this application or <br /> permit. <br /> f'/Ve %/1/ -ei/lTnehm4N <br /> First Middle Last <br /> 1277 0,-)d hurs7 r <br /> Address <br /> ID u N cf /�r Al JU - CS3 <br /> City State Zip <br /> q 72 i- a 511 <br /> Phone <br /> I understaid my rights as stated above. <br /> (e;LII / <br /> L -4—Y,; ;;) r Now ' , 03-2S4_2__ <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />