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� <br /> CITY of ORONU <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 /> license 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 Iicense. <br /> 3. The information may be shared with other I.ocal, state or <br /> federa]. agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Counci3. actio*� <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review privat� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> P.��,�.( ��'. eL �vc�,o�eS c O2�. <br /> Z �1 l�E V3 o VI cC-F <br /> First Middle Last <br /> 3 s5,o �ia.��e►.,�y L��,E <br /> Address <br /> � �N� �2/�t'/-t• ^'�/�--� ��'-^ <br /> City State Zip <br /> �i3 '�1 -- a8a � <br /> Phone <br /> I understand my rights s stated above. <br /> Si ature <br /> BUILDIN ZOfYING-473-7357 • ADMINISTRATION 8c FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />