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� <br /> � • <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Mnnicipal Offices <br /> • ' <br /> � _ � � On the North Shore of Lake Min.netonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would 3ike to inform you that your request for a permit or <br /> license from the City of Orono or any of its departments max 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 license. <br /> 3. The information may be shared with other local, s�ate 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 act�on <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 proc�ss this application or <br /> pe*mit. <br /> M�riw aEt� � G��''� <br /> First Middle Last <br /> 1�OZ v✓crx�n�vE" r�— <br /> Address <br /> y <br /> l�nn`� "r—"f-'>�2�' , <br /> City State Zip <br /> � 3�,�� <br /> _ Phoue � <br /> � I understand my rights as stated above. <br /> ♦ �—� , - <br /> � Signature <br /> I� . . <br /> BUILDING dc ZONING-473-7357 • ADMINISTRATION dt FINANCE-473-7358 • PUBGIC WORKS-473-7359 <br /> ASSESSING . • ' <br />