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. • <br /> � <br /> CITY of OR4N0 <br /> Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Offices <br /> � <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 /> 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 l.icense. <br /> 3. The information may be shared with other Ioca7., state or <br /> f ederal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or 3icense requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ��C��V�- � <br /> First Middle Last <br /> �' 7� � - C�/�-o� C,° I / F�' � � /2C �C.� - . <br /> Address <br /> ��--0 � ' .� � O o.� ��/, �'�f�� <br /> City State Zip <br /> �l'f� -�s��` c����zt �— <br /> Phone <br /> I understand my rights. as stated above. <br /> Signature . <br /> BUILDING&ZONING-473-7357 • ADMINTSTRATION&FINANCE-473•7358 • PUBLIC WORKS-473-7359 <br /> ASSESS[N G <br /> i <br />