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if*-'" ' <br />'9:v <br />W i <br />L. .Cvv <br />*j;,. <br />tr <br />tT <br />'Brr <br />|: " <br />lu . <br />■ ' i^Trrvf^ <br />CIE^ <br />oHfotHcr <br />’ <br />CITY of ORONO <br />Post Office Box 66*Crysiai Bay. Minnesota 55323 • Munidpai Offices <br />On the North Shore of Lake Minnetonka <br />DATA PRIVACY APyiSORT <br />i <br />«(* ; ' • <br />7. <br />in accordance with M.S. 13.04, Subd. 2, "Rights o£ subjects of <br />data*# wa would like to inform you that your request -or a permit or <br />liUnaf from the City of Orono or any of its departments may require <br />you to furnish certain private or confidential information. <br />\P.:fe <br />1 r <br />i'P. <br />•B. <br />/I ■ ' • I <br />■m <br />a;a: <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 license. <br />3a The information may be shared with other I-o^al, sj:ate or <br />federal agencies to the extent necessary to process the permit o- <br />license. <br />4. If your requested permit or license requires Council action <br />to approve, some information may become public. <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 />> <br />____________ <br />First Middle Last <br />/ffO <br />Address <br />City <br />Phone <br />X understand my rights as stated above- <br />.gnature <br />RilUmG a ZONING - 47M3S7 <br />AitisnNC <br />administration a finance - J73-7358 PUBLIC WORKS - 473-73S9 <br />m.