Laserfiche WebLink
� <br /> � ��. <br /> �� <br /> � �� � CITY of ORONO <br /> <�„� � <br /> � <br /> Post Office Box 66•Crystai Bay, Minnesota 55323•Municipal Offices <br /> 0 <br /> � _ � g 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 3ike to inform you that your request for a permit or <br /> ].icense 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 , 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 Councii actior. <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 /> L o ti ,��4�,r� ��ur��'�1���/� <br /> First Middle Last <br /> .3-Z�S �NS+G1�1 �`1 V�:. NO. <br /> Address <br /> ��, �,���� ,�,� SS4-�7 <br /> City State Zip <br /> S�9 - 000`� <br /> Phone <br /> I under and my rights as stated above. <br /> Signature . <br /> BUILDING&ZONING—473-7357 • ADMIMSTRATION&FINANCE—473-7358 � PUBLIC WORKS—473-7359 <br /> ASSESSING <br />