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� R <br /> CITY of ORONO <br /> C�ZIt : <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> OF- <br /> -.ORONO' 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 confidential departmentsayrequire <br /> you to furnish certain private <br /> You are notified that: <br /> 1. The information hey° nish will or licensebe used to requested, determine your <br /> a <br /> qulification Permit <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 , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requ isted formationtmoray become publicense gic uirres Council action <br /> to approve, some <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 process this application or <br /> permit. <br /> First <br /> Middle Last <br /> Address <br /> City State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILDING&ZONING—473-7357 <br /> • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />