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, � <br /> "'�''� :.,� , a�'< <br /> � �� �:, <br /> Ku�^� �� .:��= CIT�' of ORON(� <br /> �� � Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> � <br /> �- y - � � � 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 Iike to inform you that your request for a permit or <br /> Iicense 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 will 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 local , state 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 actior. <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 /> �,�Gp LArErCn�G� j'�e�yl-Z, <br /> First Middle Last <br /> y�S �4�,� �9UG. <br /> Address <br /> G Oiv.� ���'f�,� �/J� -s-�.3�� <br /> City State Zip <br /> 5✓7�,3"�2 S� <br /> Phone <br /> I understand my rights as stated above. <br /> G <br /> ignature <br /> BU[LDING&ZOIVING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />