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o �,, � � <br /> � � � , <br /> .�� _��.- : _ � '�`� Y of ORONO <br /> . ��; CIT <br /> � �`���=} �, ' ri��o� <br /> '� ^�� ��' =r -'' �G, �! Posc offce sox 66 <br /> \\L� �� � j�� / Crystal Bay,Minnesota 5532�-0066 <br /> '� i"1�!�:';�' ��, �j�'%� <br /> :, . ,M,1�;_ -�., .�, ,, <br /> 9 ����� �. � ,,: <br /> k�K� -� <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, c�aetfroms the Cityf of Oronoe or�anylofe its <br /> inform you that your request for a permit or li <br /> deparunents may require you to furnish certain private or confidential information. <br /> You ar� notified that: <br /> l. The information you furnish will be used to determine your qualification for the <br /> permit or license requested. <br /> �. You may refuse to supply data, but refusal may require that the Ciry deny the <br /> �ermit or license. <br /> 3. The information may be shared eit�h�°to= li ense state or federal aQencies to the <br /> eYtent necessary to process the p <br /> 4, If your requested permit or license requires Council action to approve, some <br /> information may become public. <br /> �, You have certain ri�hts under M.S. 13.04 (see followinJ paQe) to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> PLEASE PRL\'`I' <br /> � � Last <br /> First Middle <br /> �3 5 �'t c ke l.c�,ke ��'tv e <br /> Address <br /> 5535 6 `�l 3- � � 5 � <br /> � Phone <br /> Cirv Stace Zip <br /> I understand my riahts as stated above. <br /> SiQ ature <br /> V TELEPHOti'E-473-7357• E�.Y-473-0510 <br /> 10 <br />