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. <br /> •' '* ., <br /> �:.� .:_.�` . <br /> �� �� <br /> �� ��� ����� <br /> �. � ���- �I'��' �� <br /> t .� � �.-�.�-;, <br /> _��r <br /> !1 ��--��;: Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> # �. <br /> 0 <br /> �. _ � ov2� On the North Shore of Lake Minnetonka <br /> DATA PRNAC�' AD�TI S ORY <br /> �In accordance with M.S. 13.04 , Subd. 2 , "Rights of subermit or <br /> data", we would like to inform you tha,t your request for a p <br /> license from the City of Orono or any of its departments may require <br /> y,ou to furnish certain private or confidential information. <br /> You are notified that: • <br /> 1. � The information Y°ermit or licensebrequet ed, determine your <br /> Qualification for the p <br /> 2. You may refuse to suppl.y data, but refusal may require that <br /> the City deny the perntit or Iicense. <br /> 3. The information may be shared with other local , s�ate or <br /> federal. agencies to the extent necessary to process the permit or <br /> I.icense. <br /> 4. If your requested permit or Iicense requires Councii ac��or_ <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 5 . Your full name is required �o proc�ss this application or <br /> pe?.nit. , <br /> � <br /> First Middle Last <br /> �� <br /> Address • <br /> �� ,. r� <br /> 1�1�„� �'�3 � � ' <br /> City State GlU <br /> � �-{�.a.-��o s� <br /> Phone <br /> I understand my rights as stated above. <br /> / Siq re � � <br /> BUILDING& ZONING—473-7357 <br /> � ADMINISTRATION&FINANCE- -173-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />