Laserfiche WebLink
• � 1 <br /> . • <br /> "`l <br /> • • 4 <br /> CITYof ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> •`�K a40.4 49 44} On the North Shore of Lake Minnetonka <br /> • <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 15. 165, "Rights of subjects of data" , <br /> 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 <br /> require you to furnish certain private or confidential inform- <br /> ation. <br /> You are notified that: <br /> 1 . The information you furnish will be used to determine <br /> your qualification for the permit or license requested. <br /> 2 . You may refuse to supply data, but refusal may require <br /> that the City deny the permit or license. <br /> 3 . The information may be shared with other local , state <br /> or. federal agencies to the extent necessary to process <br /> the permit or license. <br /> 4 . If your requested permit or license reqires council <br /> action to approve, some information may become public. <br /> 5 . You have certian rights under M.S . 15. 165 to review <br /> private data on yourself. <br /> • <br /> 6 . Your full name, and date of birth are required to process <br /> this application or permit. <br /> • ('/i,iLG; it( _ <br /> First Aird e Last <br /> / G 7c( / <br /> Address <br /> r Ii ui vi:Zitt <br /> Date of birth (does not apply to building/general permits) <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />