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'^�r �G���x � <br /> �i � <br /> +r"!i if i tf <br /> � �� � CITY of ORONO <br /> � <br /> �.����,��- <br /> Post Office Box 66•Cryatal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � - v � 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 like 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 supp].y 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 �o review pri�a�� <br /> data on yourself. <br /> 6. Yaur full name is required to process this apglicatian or <br /> permit. <br /> /1 G% �7�i"��7 /� �c�c� /C��� <br /> First Middle Last <br /> �_ � �� � 6-U-; , �t � <br /> Address <br /> .-e'� :� r � � � <br /> City State Zip <br /> 7 ,?v <br /> ��/� `�'/� �" � <br /> Phone <br /> I understand my rights as stated above. <br /> , <br /> �,i '%,��" ,� <br /> Sig ature _ <br /> BUILDING&ZOMNG—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESS[NG <br />