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� ,��.,� <br /> ; <br /> �t � ; <br /> � ��� CITY of ORONO <br /> - °.,�}'.i��:�,Y!.. <br /> 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 /> 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 in=�rmatior, i7C:: �'.=�Zi=rt �d?�. � r'�= ����� t� dAtermir.e VOtlr <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 grocess the permit or <br /> 3.icense. <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 to review prica�� <br /> data on yourself. <br /> 6. Your full namP is required to process this applicaticn or <br /> permit. <br /> a. , <br /> . , , , , . , <br /> , . <br /> ._ , . . <br /> , ._ , . , . <br /> .�- <br /> i �.)r>,/:= R- . ,/ �,,._; , �. ' e- W- <br /> First Midd3e Last <br /> Address <br /> � <br /> ..;'//'� i% ;�-'�? �� /'; /Ci� `' �' :J` <br /> City State Zip <br /> '/�7� . -� <br /> i ' ' ~�` <br /> P:�one <br /> I understand my rights as stated above. <br /> ��, �-,�� . <br /> Signature '� ' <br /> „Z�ri.-l�+r� /�i l <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-�359 <br /> ASSESSING <br />