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1 • <br /> ��� }� <br /> �����'�)� . '�'.. <br /> � � <br /> � F� �Sh f I,, f an <br /> ���--' � CITY of ORONO <br /> ,a r .�� <br /> � �� , <br /> , <br /> £ ,.. <br /> `�"`'7'"�+1� 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 subjects of <br /> data", we would like to inform you that your request for a permit or <br /> Iicense 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 /> 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 ar license. <br /> 3. The information may be shared with other Iocal, state or <br /> federal agencies to the extent necessary to grocess the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense requires Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 Lo review pri�a�� <br /> data on yourself. <br /> 6. Yaur full name is required to process this apt•licaticn or <br /> p�rmit. <br /> �� c�►�� �x'� --� - <br /> First Middle Last <br /> � L/� � l��..-�� 1(�l>�`�C��l � � <br /> Address <br /> .�� ► ,�r�-�-�2��,+-.�4 � 2 �1 , �5 3�1 <br /> City State Zip <br /> l���-.'� J `/ ,,f% � <br /> Phone <br /> I understand my rights as stated above. <br /> Si ature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION& FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />