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.� <br /> . � <br /> � NO <br /> C ITY of ORO <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 subjects of <br /> data", we would like 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 /> 1. The information you furnish wi3.1 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 witM other local , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> I.icense. <br /> 4. If your requested permit or Iicense requires Councii act�or. <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. Your full name is required to proc�ss this application or <br /> permit. <br /> G~ Middle Last <br /> First <br /> ��305 S <br /> Address <br /> 1 c �v 5� 943 <br /> City State Zip <br /> 43S 0557 - <br /> Phone <br /> I understand my rights as stated above. <br /> ' gnat re � <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&F[NANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />