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. <br /> 1 _ No <br /> C ITY of ORO <br /> Post Office Box 66•Crystal Bay.Minnesota Sa323•Muni�ipal Of�� <br /> • <br /> � _ � + On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "RighS� forsa b er it or <br /> data", we would Iike to inform you that your reque P <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 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 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 Councii action <br /> to approve, some information may become public. <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 application or <br /> permit. <br /> � � 'TY Y`1�S �� <br /> First <br /> Middle Last <br /> � � <br /> Address <br /> � r, ,� �ZiP <br /> City State <br /> �-��-qass <br /> Phone <br /> I understand my rights as stated above. <br /> . � <br /> Signature � <br /> BUILDING&ZONING-473-7357 • ADMINISTEtATION&FINANCE-473-7358 <br /> • POBLIC WORKS-473-7359 <br /> ASSESSINC <br />