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r• <br /> � . <br /> ` �,� <br /> �iCt��:, tGt.�� '�g <br /> �l� 7��:..�hY1.�-: <br /> x;'a p.,'�:. <br /> �'�� X 1 F�fi:�: <br /> ,� r`Yi!'' � � W:r "S <br /> : �k r�� ��r`-� � CITY of ORONO <br /> _ , _._ <br /> ..�w, <br /> � �'��'�� ' Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> _���� a <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 /> 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 /> 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 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 /> 4. If your requested permit or 3.icense 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 pri�at� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> Jaries �^�alker <br /> First Middle Last <br /> 1495 Greentrees Road <br /> Address <br /> Orono r'iv 55391 <br /> City State Zip <br /> 476-1774 <br /> Phone <br /> I understand my rights as stated above. <br /> � � � <br /> � �✓,-�-�-�, �ti� �.,t� � <br /> ' n tur <br /> i <br /> , � <br /> BUILDING&ZON[NG—473-7357 • ADMINISTRATIOfV&FINANCE—473-7358 • PUBLIC WORKS—473-7359 � <br /> ASSESSING i <br /> � <br />