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� • � <br /> /�.���,,,,���'� � i <br /> 4 r� <br /> C�A+ *R � � c9L� <br /> f x '''� <br /> 'Er <br /> ` � `� �� : � CI'�Y of ORONO <br /> ; �- <br /> -�� ��:4 K���: <br /> � Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> �9 <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 like 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 will be used to determine your <br /> qualification for the permit or Iicense reguested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or license. <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 /> Iicense. <br /> 4. If your requested permit or license requires Counci3. action <br /> to approve, some information may become pubiic. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�L <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> ,�' � i�� � �; �� �� <br /> �' , <br /> First Middle Last <br /> v� �.J�'. � �� ��-, <br /> �� d� / .c_� <br /> Address <br /> ��� / ��� �� <br /> � fi4�--- ✓ -` � <br /> City State Zip <br /> ��i��-�'_�C"�', <br /> Phone <br /> I understand my righ s as stated above. <br /> �� �� . <br /> Signature . <br /> � <br /> � <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />