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'� �� � <br /> � - �I'�I' of ��Ol�TO <br /> :� <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal OfSces <br /> • <br /> � _ � v On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVIS�RY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of sub erm t o= <br /> data", we would li ke to in f orm you that your request for a P require <br /> license from the City of Orono or any of its departments may <br /> you to furnish certain private or confidentia3. information. <br /> You are notified that: <br /> 1. The informati�heY°ermit or licensebrequested, determine your <br /> qualification for P <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The inf ormat�o the e tenthnecessaryhto processcthe pe�it �r <br /> federal agencies <br /> license. <br /> 4. If your requested permit or become e ub qic.res Councii ac��or. <br /> to approve, some information may P <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 to proc�ss this application or <br /> � permit. <br /> t � � <br /> First <br /> Middle Last <br /> � � �^ <br /> _� ) <br /> Address �--Y-- � <br /> ` � � <br /> City State Zip <br /> � ��� � ---- <br /> Phone <br /> I unde ta rights as stated above. <br /> , <br /> Sig ure ' � <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS —473-7359 _ <br /> ASSESSIN G <br />