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� <br /> �.��ri <br /> s !`,�'� ''�*.�;� <br /> i 5 <br /> $ <br /> ` � � ��j{�� CITY of ORO�TO <br /> x ' „ a��� <br /> C �;'�:> <br /> 1s'��";_� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <br /> i �4-�s <br /> .:.-�x <br /> i - ,� ``�` On th.e 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 Iike to inform you that your request for a permit or <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 /> l. The information you furnish wil.l. be used to determine your <br /> qualification 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 Iicense. <br /> 3. The information may be shared with other IocaZ , 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 Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6. Yc�ur full name is required to process this applicatian or <br /> permit. <br /> e �,�_ -E i' o� <br /> First Middle Last <br /> 3%.�� /�� c ��or �1�.—� c- -'2 <br /> Address <br /> � -_ � � <br /> City State Zip <br /> �l�7�- �r�`,� <br /> Phone <br /> I understand my rights as stated bove. <br /> �- i- <br /> ignature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />