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, <br /> ����� . , <br /> � i �� <br /> �;�� �� ,�� <br /> i : �'? <br /> m�� � '�� }� C�TY o� ORONO <br /> � �, <br /> . . • �.,���� kr�-F� <br /> L' � , . <br /> � t <br /> ��: <br /> �a;` � . ;� `: <br /> ^�' Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <br /> s - � � On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would Iike 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 /> qua].ification for the permit or Iicense 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 , state or <br /> federal. agencies to the extent necessary to process the permit or <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 pri�a�� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> / 7 <br /> c"-t�� �c�'/'h y ��'""v �-,' �� <br /> First Middle Last <br /> �-�'7.3 �'��u.�-�,,�- �( <br /> Address <br /> G )CG�/,S%u r�O�Poiva� /�/!J -S .5 -��� <br /> City � State Zip <br /> _ �',,�/ — � �`1s <br /> Phone <br /> I understand my rights as stated above. <br /> .�--r-:� -r-�-------- <br /> ture <br /> BUILDING&ZONIIYG-473-7357 � ADMIN[STRATION&FINANCE-473-7358 • PUBLIC WORKS -473-7359 <br /> ASSESSING <br />