Laserfiche WebLink
:` F <br /> i,, ,_:,.,:„....„ CITY of ORONO <br /> cPost Office Box 66•CrYstal Bay, Minnesota 55323•Municipal Offices <br /> _- <br /> i,=aaaNcr 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 request fora 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 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 recuires Council action <br /> to approve, some information may become public. <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 /> Fi c_ 1,...,le ,,,_ ,,,,_..) <br /> • First Middle Last <br /> Address <br /> fro ze-3..1 I /4iJ 6---:<-- //L, <br /> City State Zip <br /> G/7/— i/,- - V <br /> Phone <br /> I understand my rights as st- ed a ove. <br /> 72/ <br /> G <br /> '''gnature • <br /> • <br /> BUILDING& ZONING - 473-7357 • ADMINISTRATION& FINANCE- 473-7353 • PUBLIC WORKS -473-7359 <br /> ASSESSING <br />