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. � � � <br /> , <br /> � <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municapal Officea <br /> • <br /> � - � � On the North Shore of Lake Minnetorcka <br /> DATA PRNACY 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 /> Iicense 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 requested. <br /> 2. You may refuse to supply data, but refusal may require thaL <br /> the City deny the permit or license. <br /> 3. The inforination 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 Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 �o review prica�e <br /> data on yourself. <br /> 6. Yaur full name is required to process this applicatian or <br /> permit. <br /> ����1Z� �-�-b�t-15 L �� <br /> First Middle Last <br /> 4r-� �O �L�t� �v. 1..1�^tZ�,-� <br /> Address <br /> ��i ����J�� 1�✓�L-Y� �ti • ��.J`� �L <br /> City State Zip <br /> � ��-O�S2 <br /> Phone <br /> I understand my rights as stated above. <br /> �)� a,�%�- ��G��-�-�-` <br /> Signature � <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS -473-7359 <br /> ASSFSSING - <br />