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CITE' ©f ORONO <br /> M <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 /> f subjects of <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights o <br /> t- for a permi <br /> data" , we would like t or <br /> to inform you that your requtm <br /> license from the City <br /> of Orono or any of its departments may require <br /> you to furnish certain private or confidential information. <br /> you are notified that: <br /> you furnish will be used to determine your <br /> 1. The information oquested. <br /> aual.ification for the permit or license r� <br /> , but refusal may require that <br /> 2. You may refuse to supply data <br /> the City deny the permit or license. <br /> 3 . The information may be shared with other local , state or <br /> federal agencies to the extent necessary to process the permit <br /> o <br /> � <br /> license. <br /> permit or license requires Council act-40r. <br /> if your requested tebecome public. <br /> to approve, some information maY <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> uired to process this application or <br /> 6 . Your full name is rec <br /> permit. <br /> Last <br /> First Middle <br /> 1 C 1E_ <br /> Address <br /> � - -Tc„­ t`-�'�' Zip <br /> City <br /> State <br /> Phone <br /> 1 understand my rights as stated above. <br /> Signature <br /> �2 <br /> • PUBLIC WORKS—473-7359 <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> ASSESSING <br />