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; � � . . <br /> � <br /> C ITY of ORONO <br /> Post Office Box 66•Cryatal Bay,Minneeota 55323•Municipal Officea <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 subjects of <br /> data", we would like to inform you that your request for a permit or <br /> Zicense 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 /> qual.ification 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 Zicense. <br /> 3. The information may be shared with other I.ocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Counci3. action <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 /> NI �-l� ����� L..�rr�sa� <br /> First Middle Last � <br /> 3 6 � JV D 12 7�-t �-�2� Y--�9'nl� <br /> Address <br /> ��20�o M ,v 5�3�4 <br /> City State Zip <br /> �-��-- �7a33 <br /> Phone <br /> I understand my rights as ate above. <br /> Sign tu e <br /> BUILDING&c ZONING—473-7357 • ADMINISTRATION bE FINANCE—473-7358 • PUBLIC WORKS—473-�359 <br /> ASSESSING <br />