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. -- �- � <br /> � <br /> . �I�C�.' O� OR�1.1T0 <br /> Post Office Box 66•Crystal Bay,Minnesota 5�323•Municipal Offic� <br /> • � . <br /> � � o �. On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of sub erm t or <br /> data", we would like to inform you that your request for a p <br /> license from the City of Orono or any of its departments may require <br /> you to furnish certain private or confidential inforination. <br /> You are notified that: <br /> 1. The information you fu�or ii ensebrequested. determine your <br /> qualification for the permi <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 iocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested Pe lon mar become publiclres Councii action <br /> to approve, some informat Y <br /> 5. You have certain rights. under M.S. 13.04 to review prica�� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. • <br /> �l�xG��n►� � <br /> �-� �iS he� <br /> Middle Last <br /> First �� <br /> ��� �� �� <br /> , <br /> Address <br /> D,�Dy1 � Y�'l � hl� �"��� � <br /> City State Zip <br /> �/oZ �7� _" �a7� <br /> Phone . <br /> I understand my rights as stated above. � <br /> ' � � <br /> Signature � <br /> BUILDING&ZONING—473-7357 • ADMIN�STTtATION&FINANCE—4�3-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />