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r C.>.: <br /> �,�- _ _- <br /> Y'� �r ' <br /> �� � t 1_ <br /> xr�,�;�. � y��m,t <br /> Tt$`� �^ <br /> �z����� � �� (����' o� ���1�� <br /> .� x , r fr � <br /> rs':� }?'.g '�-t t"'CC <br /> [�§: <br /> �+e�V'�V^"'`'�� �..�. <br /> ���y Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> � � �� <br /> °=� �����`�'�� <br /> `�� "�� ` ; " Orc the North Shore of Lake Minnetonka <br /> � - ! A�.. <br /> DATA PRNACY 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 any of its departments may require <br /> yau to furnish certain private or confidential information. <br /> You are notified that: <br /> l. The information you furnish wil. l be used to determine your <br /> qual.ification for the permit or Iicense requested. <br /> 2. You may refuse to suppl.y data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may be snared with other Iocal , s�ate 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 actior. <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 /> �' � /��-' L� S �o �Xr�,L <br /> First Middle Last <br /> ��l%� Do!/���-s �� �i <br /> Address <br /> �� ,�UGsCLY� �ff�� 55 �� � <br /> City State Zip <br /> � 33 -� � �� <br /> Phone <br /> I understand my rights as stated above. <br /> � <br /> � __ <br /> Signature <br /> Bt!ILD[NG&ZONING—473-7357 <br /> • ADMINISTRATION&FINANCE--173-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSIN G <br />