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A..., <br /> . . <br /> A <br /> . CITY of ORONO <br /> CITY Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> OF <br /> ORONO 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 in orm you that your request for a permit or <br /> license from the City of 0 ono or any of its departments may require <br /> you to furnish certain pri ate or confidential information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your <br /> qualification for the ermit 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 with other local, 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 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 /> (4g14_ �dle��jj (2—Trj <br /> First <br /> Last <br /> l IOC T t1 /441E_________ <br /> Address <br /> Clx - ' ..%. - , i h.- '-S1 (C ( <br /> City 1 State Zip <br /> 74 _ -7 ( <br /> Phone <br /> I understand ,. , rig as stated above. <br /> Signatu e <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br /> I <br />