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Y <br /> {Z- <br /> ` <br /> W r <br /> NOW. <br /> CITY®f ORONO . . <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> 0 <br /> On the North Shore of Lake Jlfinnetonka <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 /> licensefrom 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 /> qualifi cation for the perm, it or license requested. <br /> 2. You may refuse to supply data, but re=usal 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 requested permit or license requires Council action_ <br /> to approve, some information may become public. <br /> S. 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 /> Firsclt Middle p `La <br /> QTS- CAJ <br /> Address <br /> City State Zip <br /> 4f 7 3 -7 <br /> Phone <br /> I understand my rights as stated above. <br /> �EJN-0 <br /> • Signatu e <br />'ILDING& ZONING —473-7357 • ADMINISTRATION&FINANCE— 473-73:3 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />