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V-. <br /> . —• <br /> � <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•MnniciPal Offi�es <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 sub e��t or <br /> data", we would like to inform you that your request for a p <br /> license f rom the City of Orono or any of its departments may require <br /> you to �urnish certain private or confidential information. <br /> You are notified that: <br /> 1. The information you furnish wil.l 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 Iicense. <br /> 3. The information may be shared with other 3.oca1 , state 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�or. <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 /> � � �� � � <br /> First Middle Las <br /> �-s� ��y - .� <br /> Ad ress ^ <br /> ��U <br /> n� <br /> City ^ State Zip <br /> ���� ���� � <br /> Phone <br /> I understand my rights as stated above. <br /> �!(/ ` <br /> . <br /> ign re � <br /> BUILDING&ZON[NG—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSiNG <br />