Laserfiche WebLink
c <br /> ` <br /> - C ITY of ORONO <br /> Post Office Box 66•Ctystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � - � � 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 inform you that your reques� 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 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, s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or license requires Council act�on <br /> to approve, some information may become pub3.ic. <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 /> G�`h �/1 d/Aaf /�/o���'int '�s�l' <br /> First Middle Last <br /> 7oq �-r7"�k� h�.Q�Iari d �h <br /> Address <br /> L v.,� (�li.� t�in ss"3r6 <br /> City State Zip <br /> u�11- �l 7.�- �/ o� � <br /> Phone <br /> I understand my rights as stated above. <br /> ���-`-, � <br /> Signature �� � <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />