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�.���t <br /> '�c..s1FeA:. . yy <br /> h"{�'^ T,� <br /> ryY���� CI�Y o� ORONO <br /> �a.F:r <br /> ���;;:. <br /> .�'° Post Office Box 6&•Crystal Bay,Minnesota 55323•Municipal Offices <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 subjects of <br /> data", we would Iike to inform you that your request for a permit or <br /> license f rom 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 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 Iicense. <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 /> a. If your requested permit or Iicense requires Council action <br /> to approve, some information may become publ.ic. <br /> 5. You have certain rights under M.S. 13.04 to review pritia�� <br /> data on yourself. <br /> 6 . Your full name is required to process this applicaticn or <br /> permit. <br /> ��1� `� -�, ��'� , ; �, ' i� /' <br /> i i', , / " C/,' , ; , ,� <br /> First Middle Last <br /> Address <br /> City State Zip <br /> -- , �, ;- <br /> Phone <br /> : <br /> I understand my rights as stated above. <br /> ��/� ;. . <br /> � � < ,✓ <br /> yr . ,�, <br /> _�/ ;�� } <br /> Signature � <br /> �". <br /> ., <br /> , ' • AD�iINISTRATION&FI�ANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> BUILDItiG'&ZONING—473-7357 <br /> ASSESSI�IG <br />