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� <br /> . O ,�.',,, <br /> � , <br /> ;�4 ���;�. <br /> �! ---; _ ��� C ITY of ORONO <br /> �� � �,������-;�:r� �,,'� h���o� <br /> � ,k, • - -%" �, ; Post Office Box 66 <br /> � ��'. �' ���t `�, ;j� Crystal Bay,l�iinnesota 553Z�-0066 <br /> ,�i: ,r <br /> \'t �i . ,�:1•, -�,�'�G -/ <br /> ;,_ <br /> �9kESIH���'�, <br /> ������� <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2,lc�ae tfroms the Cityj of Oro oe or�any lofe its <br /> inform you that your request for a permit or 1 <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 determine ;�our qualification for the <br /> permit or license requested. <br /> ?. You may refuse to supply data, but refusal may require that the City deny the <br /> permit or license. <br /> 3. The information may be shared with other local, state or federal aQencies 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 cenain ri�hts under M.S. 13.04 (see followin; paQe) to review private <br /> data on yourself. <br /> (, Your full name is required to process this application or permit. <br /> PLEASE PRIl�'T <br /> ��� �� �� iti G�)J /t,�� !`_ <br /> First Midd e Last <br /> �� 3 l C-� Sc� C�►- <br /> Address <br /> �i rb N ; 1l� c�j 5� 3`1 � �7/- 7 �'S-S-. <br /> Citv <br /> Stace Zip Phone <br /> I understand my riahts as stated above. <br /> � <br /> � �rn <br /> SiQnarur <br /> � TELEPHO!YE—473-7357• F.�+..Y-373-0510 <br /> 1� <br />