Laserfiche WebLink
� <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Offiees <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 /> d ta , we would Iike to inform you that your request for a permit or <br /> ic se from the City of Orono or any of its departments may require <br /> ia o furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The information you furnish wi1.1 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 license. <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 Iicense requires Council act�on <br /> to approve, some information may become public. <br /> ' 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ��s�� I��d�-� ) r �f�C� <br /> First Middle Last <br /> j.� a�o�-r� �� �� <br /> Address <br /> o,� � n � .�5 3 5� <br /> City State Zip <br /> ' `��� � ��/ <br /> Phone <br /> I un and y ri s stated above. <br /> � <br /> ,_/" <br /> , Sig ture . <br /> B 1�.DI G&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> AS SSING <br />