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. <br /> � <br /> C ITY of ORON� <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> s - � � 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 /> 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 /> 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 3icense. <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 publ.ic. <br /> 5. You have certain rights under M.S. 13.04 to review pri�ate <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> E�7�� �(�� � l�-S �" `�j �..._ l/�.L° _ <br /> First Middle Last . <br /> / 3� �v �kc��(�., �as— � c� <br /> Address <br /> �1 �,�� �''�1 nJ �S �`�{ � <br /> Cit State Zip <br /> 3 -� .�o <br /> Phone <br /> I u ers nd my igh as stated above. <br /> - ��� � <br /> Sig ature . <br /> BUILDING 8c ZONINC—473•7357 • ADMIIVISTRATION�c FINAIYCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />