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(. \~ <br />0 ,:& <br />~µ:..'·•· i'L:J <br />CITY of ORONO <br />Municipal Offices <br />Street Address: <br />275 0 Kelley Parkway <br />Orono, MN 55356 <br />DATA PRIVACY ADVISORY <br />Malling Address: <br />P.O. Box .66 <br />Cry stal Bay, MN 55323-0066 <br />In accordance with M.S . 13.04, Subd. 2, "Rights of subjects of data", we would like to <br />inform you that your request for a permit or license from the City of Orono or any of its <br />departments may require you to furnish certain private or confidential information. <br />You are notified that: <br />1. The information you furnish will be used to detern1ine your qualification for the <br />permit or license requested. <br />2. You may refuse to supply data, but refusal may require that the City deny the permit <br />or license . <br />3. The information may be shared with other local, state or federal agencies to the <br />extent necessary to process the permit or license. <br />4. If your requested permit or license requires Council action to approve, some <br />information may become public. <br />5. You have certain rights under M.S. 13.04 (see following page) to review private data <br />on yourself. <br />6. Your full name is required to process this application or permit. <br />G-~~tRK \L · J~NY\-1\J , ~-.7 Middle First Last <br />l~s:-s 'D:J~s. n;~, <br />Address <br />0~) <br />City <br />~(J 652)'1 { <br />State Zip <br />Telephone (612) 473-7357 • FAX 473--0510 <br />10 <br />Phone