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� <br /> � . <br /> .'�,;� <br /> �rx �'�aic�,.. <br /> , ��d ����'�x ~� o <br /> ��'< .=��r,..��~r�`..T C I�Y of ORO� <br /> � 7 <br /> � ;�-,e.��;� <br /> ;'�� �t � Post Office Box 6&•Crystal Bay,Minnesota 5a323•Municipal 4ffices <br /> -U�_. . <br /> ! � <br /> � ' a � • On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> ��In accordance with M.S. 13.04 , Subd. 2, "Rights of subjects of <br /> data , we would Iike to inform you that your request for a permit or <br /> license fromri certain pr vate or onf dential e nf rmationmay require <br /> you to furnis <br /> You are notified that: <br /> 1. The information you furnish wil.l be used to determine your <br /> qualification for the permit or license reques�ed. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or Iicense. <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 Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Yaur ful.l name is required to process this application or <br /> permit. <br /> �N � - � ���''.� <br /> First Middle Last <br /> ��L� C'����i��� -�tii'z-�-� <br /> Address � <br /> I '��' ,�^�IC. _ ��S <br /> City tate Zip <br /> �'� � �f � `� <br /> Phone <br /> I un rstand my r' ghts as sta'ted above. <br /> \ ' � _ <br /> Si ature <br /> BUILDING&ZONING-473•7357 • ADMINISTRATION&FINANCE-473-7358 <br /> • PCBL(C WORKS -473-7359 <br /> ASSESSI:VG <br />