Laserfiche WebLink
'.''>\ <br />'g <br />.. , =·1 ,• <br />.,,,.tt2:= <br />.str;!<J,' ··\•·J1 <br />' ·, <br />CITY of ORONO <br />Municipal Offices <br />Street Address: <br />2750 Kelley Parkway <br />Orono, MN 55356 <br />DATA PRIVACY ADVISORY <br />Mailing Address: <br />P.O. Box 66 <br />Crystal Bay, MN 55323-0066 <br />In accordance with M.S. 13.04, Subd. 2 , "Rights of subjects of data", we would like to <br />inform you that your request for a permit or license from the City of Orono or any of its <br />departments may require you to furnish certain pri vate or confidential information. <br />y OU are notified that: <br />1. The information you furnish will be used to determine your qualification for the <br />permit or license requested. <br />2. You may refuse to supply data, but refusal may require that the City deny the permit <br />or license. <br />3 . The information may be shared with other local , state or federal agencies to the <br />extent necessary to process the permit or license. <br />4. If your requested permit or license requires Council action to approve , some <br />information may become public . <br />5. You have certain rights under M.S . 13.04 (see following page) to review private data <br />on yourself. <br />6. Your full name is ·required to process this application or permit. <br />J)w,d Al a_" ---SLA:±b Cr I a_nd <br />First Middle Last <br />!3(£ LLy" b r-5+. eo . /3 ox , <br />Address <br />~-J ' '1.s-hJ 160!:f; f,t\ f\. $S3c)3 <br />State . Zip City <br />I understand my righ~bovf"'\ <br />XM·}51. ~ J;:: <br />Telephone (612) 47'3-7357 • FAX 473-0510 <br />10 <br />I l.o I <br />lf73 ,-Lf4~J <br />Phone