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�� .. <br /> �- <br /> �� <br /> ,: ; �� � r ��;a�. ��. <br /> K:,x.�lM.!.:w".Y �� <br /> � ���� �� ����� <br /> ���, .��' -� :.r - <br /> >n,, �.�,r <br /> �u�4'air 7u��:z..::��`�,,:_ <br /> 1as,• r--:a <br /> M..�.��*� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <br /> ' .�.:;. <br /> • - � � On the North Shore of Lake Minneto� <br /> DATA PRIVACY ADVISORY � ` I <br /> � <br /> ��In accordance with M.S. 13.04, Subd. 2, "Righ �/��� J <br /> data , we would I.ike to inform you that your reque , � <br /> license from the City of Orono or any of its depart ,��U,, / <br /> you to furnish certain private or confidential info: _ / <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your <br /> qualification 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 local , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or I.icense requires Council. action <br /> to approve, some information may become public. <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 process this application or <br /> permit. <br /> First Middle Last _ <br /> Address <br /> City State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&F[NANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />