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--:.'S.: <br /> �y <br /> � � <br /> 4 1 f:?,G _ <br /> f� j ' <br /> ;� � ..7� '•K �T. <br /> �� � � C ITY of ORONO <br /> r� �:��_ <br /> � `°�x�. Post Off ce Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <br /> ,>�.':�:- <br /> .�e'.a�!:a�- 8 <br /> . a - � , On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would I.ike 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 will 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 local, state or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <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 /> �i�'�� ��s ����c.� <br /> First Middle Last <br /> s/ /-��c%�� /-�// <br /> Address <br /> � �� �� ��� <br /> City State Zip <br /> �-�6-�5�� <br /> Phone <br /> I understand my rights as stated above. <br /> ,� <br /> /, <br /> Si natu <br /> BUILDING&ZONING—473-7357 • ADMINISTRATIOIV&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />