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� " <br /> � <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <br /> • <br /> � • � � 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 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 supply data, but refusal may require that <br /> the City deny the permit or ].icense. <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 privat� <br /> data on yourself. � <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> �v�eLL � �J� �u e� S D /�� <br /> First Middle Last <br /> f�'oS rg ; r �',`�L ,� �i G�'. So � <br /> Address <br /> /�j 7`f'a l`�/��� �-�3 0 5 <br /> City State Zip <br /> �L� 7"' � O � ,� <br /> Phone � <br /> I understand my rights s stated above. <br /> � ,<( <br /> Signatur . <br /> BUILDING 8c ZONING—473-7357 • ADMINISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />