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R <br /> ' �. <br /> -r r w+, <br /> ;��e1 � <br /> #���`������ �ITY of ORONO <br /> �..�.�;� .�:�s:. �: <br /> ,.kr;Fc:t,,"�yf,rf;;�':;^'�"z*. <br /> '��e � i+��'� �I Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> �:..����'. <br /> �x.;,'� `;s�-.,�:, <br /> �,.,� ,�-.�. <br /> ��}=�t� �A �: 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 reguest 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 /> l. 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 license. <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 Iicense requires Council action <br /> to approve, some ir.f ormation may become public. <br /> 5. You have certain rights under M.S. 15.165 to review private <br /> data on yourself . <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 /> Address <br /> --- - __ --- - -�- _ _. ..__._ _-__ - ___ ..__ <br /> _- --- -- - -..._._ <br /> City State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILD[NG&ZONING—473-735 i • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473•7359 <br /> ASSESSII�G <br />