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A., <br /> ,I=.:-:-.—...1r...- _.:,:ztf•t- CITY of ORONO <br /> ,--„,._,:___.3.-_,:,,,:: Post Office Box 66 Crystal Ba ,Minnesota 55323•Municipal Offices <br /> = <br /> ON ~` On the North Shore of Lake Minnetonka <br /> 1.431:6 <br /> DATA PRIVACY ADVISORY <br /> Subd. 2, "Rights of subjects of <br /> In accordance with M.S. 13.04 , our request for a permit or <br /> license from the City of <br /> data" , we would like to inform you thatono or any its departments may require <br /> to furnish certain private or confidential information. <br /> you <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 <br /> information may be shared with other local , state opermir <br /> to <br /> federal agencies to the extent necessary process <br /> license. <br /> 4. If your requested permit or license requires Council 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 /> First <br /> Middle Last <br /> 74m— 4z- Acs U . <br /> Address <br /> U- �� .k <br /> State Zip <br /> City <br /> Phone <br /> I understand my rights as stated above. <br /> Signature N w • <br /> 3UILDING Sc ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />