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Brown Road South
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25 Brown Road South - 03-117-23-21-0001
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99-2517, VAR
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Project Packet
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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 />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 pe ' <br />or license. <br />3. The information may be shared with other local, state or federal agencies to <br />extent necessary to process the permit or license. <br />4. If your requested permit or license requires Council action to approve, som~ <br />information may become public. <br />5. You have certain rights under M.S. 13.04 (see following page) to review private <br />on yourself <br />6. Your full name is required to process this application or permit. Sc o t:t _t:::-1Jrf±ut Q(l\_ <br />First Middle /) Last as Drou111 0d S:o <br />Addros <br />l,J~ . 13'\'::>56 c~ -~ "') ,, <br />City State Zip Phone <br />e-{_r]°l(Y/f <br />9 <br />Telephone (612) 473-7357 • FAX 473-0510
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