Laserfiche WebLink
CITY of 4RON0 <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � _ o � 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 Iike to inform you that your request for a permit or <br /> Iicense from 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 /> 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 suppl.y data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may be shared with other iocal , s`ate or <br /> federal agencies to the extent necessary to process the permit or <br /> I.icense. <br /> 4. If your requested permit or Iicense requires Councii. ac�ior. <br /> to approve, some information may become public. <br /> S. You have certain rights under �S.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required �o process this application or <br /> permit. <br /> t-� o►� 1 C' <br /> First Middle Last <br /> f , <br /> ���� ��(10 r��l I a'l� 1�11�f <br /> Address <br /> � � — � <br /> Cit State Zip <br /> y��1 -0��� <br /> Phone <br /> I understand my rights as stated above. <br /> Signature <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE -473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSIN G <br />