Laserfiche WebLink
• <br />CITY of ORONO <br />Street Address: <br />2750 Kelley Parkway <br />Orono, MN 55356 <br />Municipal Offices <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 private or confidential information. <br />You are notified that: <br />I. 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 reqmre that the City deny the <br />permit 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 <br />data on yourself. <br />6 . Your full name is required to process this application or permit. <br />?ILte_.r AL<A.k. T ha rkc/Lsol'"' <br />First <br />'f '1 0 <br />Address <br />O ro nD <br />City State Zip <br />I understand my rights ~=-a Phone GJJ -J.SI-J</01/ <br />Signature <br />½t:,~ <br />Telephone (952) 249-:00 • f 2) <br />www.ci.orono.mn.us <br />/ <br />1 <br />1