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� .'� <br /> � N� <br /> C IT�t'of OlaO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � � � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of sub er�t� o� <br /> d a t a", w e w o u l d like to inform you that your request for a p <br /> license f rom the City of Orono or any of its departmen ts m a y r e q u i r e <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> l. 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 /> 3. The information may be shared with other Iocal , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Councii act�or. <br /> to approve, some inf ormation may become publ.ic. <br /> 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6. Your full name is required to procsss this application or <br /> permit. <br /> Fi Middle L <br /> l <br /> dd ess � <br /> ( � <br /> City State Zip <br /> `� � �� O 2 C� - <br /> Phone <br /> I understand my rights as stated above. <br /> Si ure � <br /> BUILDING&ZONING-473-7357 <br /> • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />