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. � �, <br /> . <br /> �df�'»,:{�� �:.:J'b. -. . <br /> ..�sea'a�t 41X'W� ��%i\G 4�-�'�` <br /> °..'$.�` �'..J j L�-vP':•....'.;;. <br /> ��4�`� � ���: CITY of OROLITO <br /> - � � <br /> � � �: <br /> ��,,>>.�:_.v <br /> �, ,.:y-:o-a��:i<;;w;�> <br /> �' " "� � �- �" `� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> w ' � ,.� <br /> ,. ` <br /> .�, �._, <br /> w-..�• <br /> .� 't; . <br /> ,..i�`�`E':.,in <br /> � � • ��Y��`{ 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 /> 1. The information you furnish wil.l 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 3icense. <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 /> license. <br /> 4. If your requested permit or Iicense requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review privat� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> � �g �+ ��1,�-f�.,c.. <br /> First Mid Ie Last <br /> '��%'� �N��:�. 4A./�.r G�el��`'o'�'u <br /> Address ' <br /> ��i^,I,^ �� ���� �'�(�-� <br /> City State Zip <br /> �.�� � �. �-;_ <br /> Phone <br /> I understand my rights as stated above. <br /> � <br /> Sigriatu <br /> � <br /> BUILDING&ZONING—473-7357 • ADMINISTRATIOIY&FINANCE—473-7358 � PUBLIC WORKS —473-7359 <br /> ASSESSING <br />