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. � <br /> _ � <br /> � NO <br /> CITY of OI�O <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <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 sub erm t or <br /> data", we would like to inform you that your request for a 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 wil.l 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 license. <br /> 3. The information may be shared with ot rocessCthe permit or <br /> federal agencies to the extent necessary to p <br /> license. <br /> 4. If your requested permit or license requires Councii 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 /> �a,�.,,e,L (�� � J,.� , <br /> First <br /> � � Middle Last <br /> (�o . ��� 532� <br /> Address <br /> ��� � <br /> �,.� _ .����3 <br /> City State Z1p <br /> �� - ���� <br /> Phone <br /> I understand my rights as stated above. <br /> gnature • ' <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />