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�.� �.��� � <br /> �� w �� , <br /> A ��` �'�' ` � � CITY of OROl�O <br /> k� 5�' �Y <br /> � � <br /> ,r�-� ;��-., <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal OfScea <br /> • <br /> � . � � 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 Iike to inform you that your request for a permit or <br /> Iicense from 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 /> qualification for the permit or Iicense requested. <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 Iocal , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 �o review pri�at� <br /> data on yourself. <br /> 6. Yc,ur ful.l name is required to process this applicatian or <br /> permit. <br /> ������. �`����� <br /> First Mi dIe Last <br /> ���� �� � � ��� ��� <br /> Address <br /> ���� /��v �s�� / <br /> City State Zip <br /> ��q 6 8�� ��)5�-5�6� <br /> Phone <br /> I understand my rights as stated above. <br /> Signatu e <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />