Laserfiche WebLink
� ' �C <br /> �r. °t� �� <br /> } <br /> `fr5 CITY of ORONO <br /> .� �:;�:k <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> � <br /> � . � � 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 like to inform you that your request for a permit or <br /> license f rom 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 i.ocal , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Councii action <br /> to approve, some information may become publ.ic. <br /> 5. You have certain rights under M.S. 13.04 to review priva�� <br /> data on yourself. <br /> 6. Your full name is required to process this apFlicatian o� <br /> permit. <br /> � /J ��/L.C-d_�Q_-�—i <br /> U-U�-�..� _`� - <br /> First Middle Last <br /> C �/ ��1��-C� ��� ' - <br /> Address <br /> ��� Cp�- ��_ � l/j ' S5 ` �% � <br /> City State Zip <br /> � / � - � `7` � -�- _ <br /> Phone <br /> I understand my rights as stated above. <br /> .� `�0 „�-�'`��`�� <br /> � � �� �_ <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADM�IISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESS[NG ' <br />