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a ,` � <br /> � ` ITY of ORON� <br /> C <br /> Post Office Box 66•Crystai Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � _ � � On the North Shore of Lake Minneto�cka <br /> DATA PRIVACY 1�DVISORY <br /> In accordance with M.S. 13•ou/that your request for a perm t or <br /> data",; we would Iike to inform y <br /> license from the City of � ate or conf dential e nfo ationmay require <br /> you to furnish certain pri <br /> You are notified that: <br /> l. The inf orma��i�heYoe�t or Ii ensebrequested. determine your <br /> qualification f P <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 Iocal , s�ate or <br /> f ederal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense requires Councii ac��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 /> � �� s��� <br /> irst Middle Last <br /> �aS a� <br /> ddress � ��� � <br /> Cit State Zip <br /> �73 - 33 � � <br /> Phone <br /> I understand my rights as tate above. <br /> i <br /> Signature ' <br /> BUILDING&ZONING—473-7357 <br /> • ADMINISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-�359 <br /> ASSESSING <br />