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�.� . <br /> $�.r.�y� alf � <br /> ff J..�+�a C!+� ^°!IA <br /> Y Y��� ��_���� CITY of ORONO <br /> ��� <br /> �..�:_�,�-��� <br /> ..�:�� <br /> �`�''�,r�"X Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> z�t <br /> rN: <br /> �� `�=� � On the North Shore of Lake Minnetonka <br /> •��"�- � � a .� <br /> DATA__PRNACY ADVISORY <br /> In accordance with M.S. 15.165, "Rights of subjects of data", we <br /> would Iike to inform you that your request for a permit or license <br /> from the City of Orono or any of its departments may require you to <br /> furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The information you furnish wi13 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 Iocal , 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 inf ormation may become public. <br /> 5. You have certain rights under M.S. 15.165 to review private <br /> data on yourself. <br /> 6. Your full name, and date of birth are required to process <br /> this application or permit. <br /> G1enn � TilLotson- ..---------1-_�.7-29 <br /> _ . ------ _- .__ <br /> First Middle Last <br /> 1_8_7� SI1�G_ �T.QQ C�.__RCa.._ . _ _ _._ . . .. __ <br /> Address <br /> ���Tayzata riN _ _-- -�.53��.-�:c�5----- ._.---- - <br /> -- - _ --- _-- ------ ._ ---- -----._ _..__ - - -- <br /> City State Zip <br /> 471-95°? --------__.__ ___ <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILDING&ZONING—473-735 i • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />