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A _ . �� - <br /> �. <br />/ <br /> � <br /> � CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minaesota 55323•Municipal Offices <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 /> 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 /> l. The information you furnish will be used to determine your <br /> qualification for the permit or Iicense requested. <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 local, s�ate 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 act=on <br /> � to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> Jo�� N �A� ��� <br /> First Middle Last <br /> �J 2`J �• �'�'h S� • <br /> Address <br /> rnP�s rn �. ss �� d� <br /> City State Zip <br /> �J�J2.- 72�7� <br /> Phone � <br /> I understand my rights as stated above. <br /> N_ � • <br /> Signa e <br /> 11NG&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> SESSING <br />