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� �� <br /> � . � <br /> ;�� CI_�Y of ORONO <br /> :� _ <br /> Post Office Box 66•Crystal Bay,Minnesota 55323�Municipal Offices <br /> :wM 2� <br /> R <br /> / <br /> � _ e � On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of <br /> data" , we would like to inform you that your request for a permit or <br /> Iicense f rom the Citn �r�ate or conf dent a3 e nf rmationma1 require <br /> you to furnish certai p <br /> You are notified that: <br /> l. 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 local , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <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 rev�ew private <br /> data on yourself. <br /> 6 , Your full name is required to proc�ss this application or <br /> permit. <br /> P.,i. �ozonie <br /> 1755 Fargemess Pt. Rd. <br /> Wa ata MN 55391 <br /> First <br /> Middle Last <br /> Address <br /> City State Zip <br /> 5�"7/, �5�56 � <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILD[NG&ZONING-473-7357 • AD?�tINISTRATION&FINAtiCE- 473-7358 <br /> • PUBLIC WORKS -473-7359 <br /> ASSESSING <br />