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1 <br /> . 1 <br /> 1 <br /> . . 1 <br /> A1 11 <br /> 1 <br /> 1 <br /> CITY of ORONO <br /> CITY <br /> I Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> OF <br /> ORONO On the North Shore of Lake Minnetonka <br /> IDATA 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 hat: <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 /> l <br /> 3. The informatin may be shared with other local, state or <br /> federal agencies t the extent necessary to process the permit or <br /> license. <br /> re l ed permit or license requires Council action <br /> q ues�t <br /> 4. If your <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. I\ <br /> 6. Your full named is required to process this application or <br /> permit. <br /> I'll <br /> I r 6ift4 <br /> „a/..0, <br /> 0 <br /> First Middle Last / <br /> /i� (eciC / L____ <br /> Address <br /> , 4 /6 II <br /> S s-- <br /> City State Zip <br /> 3.g d ', <br /> Phone <br /> I understand right//s , s stated abo e. <br /> 4 / <br /> I. <br /> Signatur- if7 <br /> 11 <br /> 1 <br /> 1 <br /> 1 <br /> BUILDING&ZONING—473-7357 • A MINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />