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� <br /> � - O <br /> CITY of ORON <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipai Offices <br /> • <br /> � _ � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY 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 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 3.icense. <br /> 3. The information may be shared with other iocal, state or <br /> federal agencies to the extent necessary to process the permit or <br /> 3.icense. <br /> 4. If your requested permitmar become p blic res Council action <br /> to approve, some information y <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�e <br /> data on yourself. <br /> 6. Your full name is required to process this apFlication or <br /> permit. <br /> �bN�� w, �fi'�9����'•�.rc� — <br /> First <br /> Middle Last <br /> �f�3G �(/ S/�o•e� �.�', <br /> Address <br /> r�o �.�� r-°��✓ S5s'c� <br /> City State Z1p <br /> L17� --- S'Z c'Z- <br /> Phone <br /> I understand my rights as stated above. <br /> `� '�C���- . <br /> Signature � <br /> BUILDING&ZONiNG—473-7357 • ADMINISTRAT[ON&FINAIVCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />