Laserfiche WebLink
� <br /> • �, <br /> �� �#���� CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55.'i23•Municipal Offices <br /> • <br /> • _ � o On the North Shore of Lake Minnetonka <br /> D�1��l...�R�Y_.1_�CY �V�S9�� <br /> In accordance with M.S. 15.165, "Rights of subjects of data", we <br /> would like to inform you that your request for a permit or license ' <br /> from the City of Orono or any of its departments may require you to <br /> 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 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. 15.165 to review private <br /> data on yourself. <br /> 6. Your full name, and date of birth are required to process <br /> this application or permit. � <br /> -�--- ---- -. _ _. .___ ___ ---- -- -- --- -�----- -------_�---- <br /> .._. ----�----- ---- . .. <br /> First Middle Last <br /> _ ------ -- ---- _.. .__ .. _.. _ <br /> Address <br /> _._.__---�- ------ -----._.---- -------_-�-----...__ _� ---._ ._..- --- <br /> City State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> --- --- - ------- ._.. ._ . .__. . __. ....- -- _.. . <br /> Signature <br /> BUILD�NG�ZONING-473-7357 • ADMINISTRATION�.FiNANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> A�SESSING <br />