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�'�¢���.�Y lc?� <br /> `�-� �~ � CI'��' O� ORONO <br /> ,�, �.�.� _ <br /> ;��;�h� <br /> �_..�.: <br /> °:�'_;>:-` Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> '�:.:>.: <br /> �j.-,,:: <br /> ! "=��"'..;;: <br /> � _ � � ' On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of sub eerc�ts� �o� <br /> data", we would like to inform you that your request for a p <br /> Iicense from the City o��ate or conf dent al e nf rmationmay require <br /> y o u t o f u r n i s h c e r t a i n p <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 in£ormation may be shared with °t=ocessCthe permit or <br /> federal. agencies to the extent necessary to p <br /> license. <br /> 4. If your requested permit or license requires Councii ac��o% <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6 . Your fuZl name is required to process this application or <br /> permit. <br /> First <br /> Middle Last <br /> Address <br /> City State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILDING&ZON[NG—473-7357 • ADMINISTRATION&FINANCE —�373-7358 <br /> • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />