Laserfiche WebLink
L <br /> �� ts� <br /> (�I'1'Y Of ORONO <br /> ,�''�i y... ::.k <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> � <br /> � _ � � On the North Shore of Lake Minneta�ka <br /> DATA PRIVACY A�VISORY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of <br /> data" , we would Iike to inform you that your request for a permit or <br /> license f rom the City <br /> of Orono or any of its departments may require <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> l. The information you furnish will 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 Iicense. <br /> 3. The information may be snared with oth�ocesscthe permit or <br /> federal agencies to the extent necessary to p <br /> license. <br /> 4. If your requested permit or license requires Councii ac��or. <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 proc�ss this application or <br /> permit. <br /> l'� 'l � /� <br /> ��� � Middle Last <br /> First <br /> �;� _j `j J� ��,r���-'/ ✓'�/ � �� �, <br /> Address , : <br /> �%;� <br /> � �- �.�� ,��r ����� � <br /> � �:�� / <br /> City State Zip <br /> ��'�/ /// �� <br /> Phone <br /> I understand my rights as stated above. <br /> , ���� �_ _ _ <br /> � � <br /> ignature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />