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. � <br /> �� � ��� <br /> ��` '.o�,�""��.'� ;,� <br /> �����•��r���-� C ITY of UR�NO <br /> �5:�-r� .,�7 v ^ <br /> ._Lq�r,rpre} ��.i '; . <br /> �:�'� �,�y'' Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officee <br /> �,• ��,. ��{��,;;�i,.. <br /> "'": �e�� �., <br /> ��"�" On the North Shore of Lake Minnetonka <br /> .�eti �, � <br /> DATA_ PRIVACY AD_V_ISORY ' <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 Iicense <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 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 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 yourself. <br /> 6. Your full name, and date of birth are required to process <br /> this application or permit. <br /> sc a T1� �' � y � N��� solV_._._ _ - <br /> First Mid le Last <br /> 3y 1� �, h�K� �7" - <br /> Address <br /> G R� �� 9 ____________M��, ��• �� � 5 G -- - - -- - <br /> City State Zlp <br /> '� '� 9- g l � � --------._ _ -- --- <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 /> ASSESSIIG <br />