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� � <br /> � � <br /> `��:���, C ITY of OI$ON <br /> -af�.. <br /> :. t; Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <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 /> license 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 /> l. The information you furnish will be used to determine your <br /> qualification 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 license. <br /> 3. The information may be shared with other local , 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 ac�ior. <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 proc�ss this application or <br /> permit. <br /> ���c3►� 1'Y��.r�'� ,� � �-,-cr�—� <br /> First Middl.e Las <br /> -Z C� i a �^ ��� � C._ <br /> Address <br /> 1,� a� � � /� m� ��� `?/ <br /> City State ZiP <br /> �� � y- �- ��� <br /> Phone <br /> I understand my rights as stated above. <br /> � <br /> gnature <br /> BUILDING&ZONING—4�3•7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />