Laserfiche WebLink
4. +I , <br /> lip;"� {}' 'q�� _,. <br /> L:4 1, tf-c <br /> *-�ry� - CITY of ORONO <br /> Y. '.` Y Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> r 'PALM- { 4Y�:f <br /> *.d..-;-----4, ,, On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <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 /> , aryiQs_si--..._ 1 tl-e_ ILL( k._ <br /> Paaii <br /> First Middle Last <br /> la o Wttot h .v- "t Tira'- 1 <br /> Address <br /> C)V 61') 0 M.10 , 6-.5 31,e, q- <br /> City State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> I?i <br /> Sign ture <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />