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• �' . <br /> � <br /> CI�Y of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � _ � � On �he 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 inf orm you that your request f or a permit or <br /> license from the City of Orono or any of its departments ma� require <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> l. The information you furnish wi3.1 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 local , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> I.icense. <br /> . 4. If your requested permit or Iicense requires Council ac��or. <br /> to approve, some information may become public.� <br /> 5. You have certain rights under M.S. 13.04 to review priv�te <br /> data on yourself. <br /> 6. Your full name is required �o process this application or <br /> :+ permit. <br /> �'ac.,+.t e s M �G�a.c I I.va,l�o <br /> : First Middle Last <br /> . � f��� � r s C o,v s i N S�'N e e`f" <br /> Address <br /> � i uer Fa.!(S W = � y0o't a � <br /> City State Zip <br /> �� s- 3s6 - ssss <br /> Phone <br /> I understand my rights as stated above. <br /> . _ �a.Q.oQ G�G�e c�, . <br /> �- <br /> nature � <br /> BUILDING&ZONING—473•7357 • ADMINISTRATIOIY 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING • ' <br />