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� <br /> ., _ . <br /> � <br /> CITY of OROND <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � . � � 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 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 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 license 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�at� <br /> data on yourself. <br /> 6. Yaur full name is required to process this application or <br /> permit. <br /> N �v�-G� t'l/c/E.f <br /> ���� <br /> First Middle Last <br /> �'�d S ���� %�.��- <br /> Address <br /> C,�/2U�/U �nl• J4'S3coS� <br /> City State Zlp <br /> Cc���� ���r—,�5� <br /> Phone <br /> I understand my rights as stated above. <br /> ( c <br /> Signa re <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION dc FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />