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. `. <br /> ,.,U <br /> ^-r..��a• ��'Y`i ,�e <br /> k r„, 4 �y, <br /> ° '� �'� ; <br /> � <br /> �� �'��� � �:` ���� O� ����`� <br /> r <br /> p Post Office Box 66•Ctystal Bay, Minnesota 55323•Municipai Offices <br /> • <br /> . o - o o On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of <br /> data" , we would Iike to inform you that your request for a permit or <br /> license from the City of Orono or any of its departments may require <br /> you to 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 Iicense reguested. <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 �ocal , 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 Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Yaur full name is required to process this applicatian or <br /> permit. <br /> First Middle Last <br /> Address <br /> City State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> Signat e <br /> BUILDING&ZONING—473-7357 � ADMINISTRATION&FiNANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSIN G <br />