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� � <br /> � <br /> . <br /> 1 <br /> � �i�T�O� �RONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � - e • On the North Shore of Lake Minnetonka <br /> DATA PRNACY 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 confidentia]. information. <br /> You are notified that: <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 suppl.y 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 Iicense 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�� <br /> data on yourself. <br /> 6. Your full name is required to process this application or � <br /> _ permit. <br /> `� N� � <br /> F rst Middle Last <br /> ��� ���t� � 1�7 _ <br /> Address <br /> ��� �ti� . �`� �(o� <br /> City State Zip <br /> ��Z -� � �� <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION Fc FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />