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� . , <br /> �� <br /> ti � <br /> �.�.. � ,� <br /> � ����. . <br /> � CITY of ORON� <br /> 1a <br /> �''� ����` <br /> ta� � � <br /> `}�e'Ns# �:,fi,+ ,� ` ' <br /> t- <br /> ������ Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> �a::,y �•.�y�•�r•--.� <br /> �.Y�.- �?:'r?>--- <br /> �. � s ,� - ;,�,.�= On the North Shore of Lake Minnetonka <br /> � , <br /> Y � DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2, "Rights of subjects of <br /> data", we would 3ike 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 confidentia3 information. <br /> You are notified that: <br /> 1. The information you furnish wi3. 1 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 , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Councii act�or. <br /> to approve, some information may become pub3.ic. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required �o process this application or <br /> permit. <br /> Y�ll�1��-- ��� �'���K----_ <br /> ��st Middle Last <br /> U�.�;�� CU''�'�—. YV�sL„�t— <br /> �Z�--L.� �Y-�c �� a � � � �� - <br /> Address <br /> ���..C��OSIC��' �"�'"1(-1. `�J`��73� <br /> City State Zip <br /> ��12} L-1�11 ��--i�l I <br /> Phone <br /> I understand my rights as stated above. <br /> ��/�/� _ _� `-y.� �Ir�l'-'Q.--� \ <br /> Signature � <br /> N FINANCE—�373-7358 • PUBLIC WORKS —473-7359 <br /> UILDING&ZONING—473-7357 • ADMINISTRATIO & <br /> ASSESSING <br />