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A <br /> � � � <br /> � V <br /> �h� ' <br /> �F�� <br /> r � �t � rw` �i t <br /> -�rA.A�` E �` ��qt{.w-.!!� <br /> *� �� y c p <br /> `��s�y�`����� ICIT�' of ORONO <br /> .� ..� �:� <br /> �.�c� ,��#, tif <br /> ������������.� <br /> �� �' �� �� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Office� <br /> :5�� �k;:��� <br /> v-r.; . �� <br /> ` ; :E� wn�:s <br /> s� :; � � � On the North Shore of Lake Minnetonka <br /> � DATA__PRIVACY ADVISORY <br /> In accordance with M.S. 15.165, "Rights of subjects of data", we <br /> would like to inform you that your request for a permit or license <br /> from the City of Orono or any of its departments may require you to <br /> furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your <br /> qualification for the permit or license 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 local , state or <br /> federal agencies to the extent necessary to process the permit or <br />� Iicense. <br /> 4. If your requested permit or license requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 15.165 to review private <br /> data on yourseif . <br /> 6. Your full name, and date of birth are required to process <br /> this application or permit. <br /> .� � �-� � <br /> ___.___ _ _ __ _.___ ___. _ _ _ _ .__ <br /> __ . . <br /> �--_____ _.. _. <br /> First Middle Last <br /> l�0� �'en �i�� � S�u-e� - ---. _ _ - _ <br /> Address <br /> - _����-----.- -- _ ....__ ._��-- -- _.____ .�3 �-�- ---------�- <br /> City State Zip <br /> ��! � ou �C� <br /> Phone <br /> I under tand my rights as stated above. <br /> �, _... . .__'_'_'___. .__'.. ..._..___.__._ <br /> Sig ature <br /> BUILDING&ZONING—473-7357 • ADMLNISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />