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. ► <br /> v-:,--�.,_. <br /> •,, <br /> ,� <br /> -�FR�- b�^711 � �.. <br /> r�,[+'iY, e' .f #�;K� A � <br /> H <br /> t��, .� � ¢N� ����' �� ����T� <br /> ��� <br /> ��.� � ,� .,.,�.�: <br /> »�r.x'�;,�,�,+s�e�t n:ai"s�•;;, <br /> e& '�'ri .;:.§.r.z'^ <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Officea <br /> 1 <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 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 wiZl be used to determine your <br /> qualification for the permit or license 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 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 prica�� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> j,��-�,�s ��Ps T��- � <br /> First Middle Last - <br /> y��.� s G�.9 i�i� T�..�-� �� <br /> Address <br /> �i�,��P l�iC�9i�? /��l. SS .�s 5 <br /> City State Zip <br /> �73- ��/�/ <br /> —, <br /> Phone <br /> I understand my rights as stated above. <br /> Sign ure <br /> BUILDING&ZONING—473-7357 • RAT10N&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />