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a � <br /> '��� �.�<_ <br /> r'_� ���� <br /> � CITY o� OR�NO <br /> ��� <br /> ��.- ��-� �,� <br /> �. <br /> ' .a�'�':.. �:5n1C�y. <br /> ��.:.�.�.{:.�,,..,.. <br /> - Od Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> ! <br /> � _ � � On the North Shore of Lake Minnetonka <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 /> 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 /> l. The information you furnish wil.I 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 Iicense. <br /> 3. The information may be shared 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 license requires Councii. ac��or_ <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 ful.I name is required to proc�ss this application or <br /> permit. <br /> �C�,C. I � � LJ�-1�5� � <br /> �d��"T �(. I\f'� <br /> First <br /> Middl.e Last <br /> i � <br /> '��� i � <br /> Address <br /> '�(�i��e ����`�� I�.l� �� � � �1 <br /> City + State Zip <br /> `-1� � �� � f � � <br /> Phone <br /> I understand my rights as stated above. <br /> �,�i�/� ",�2-9�`-- <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />