Laserfiche WebLink
DA7A PRIVACY ADVISORY <br /> In accordance with M S 93 04, Subd,2,"Rights of subjects of data",we would like to inform you <br /> that your request for a permit or license from the City of Orono or any of its departments may <br /> require you to fumish certain private or confldential information. <br /> You are notified that; <br /> 'i The information you furnish will be used to determine your quali6cat(on for the permit or <br /> license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the permit or <br /> license. � <br /> 3. 'fhe information may be shared with other local,state or federai agencies to the extent <br /> necessary to process the permit or license, <br /> 4.. lf your requested permit or license requires Council action to approve,some information <br /> may become public_ . <br /> 5. You have certain rights under M,S, 13�04(see following page)to review private data on <br /> yourseif, . <br /> 6. Your full name is required to process this application or permit. <br /> Roger D. 0'Shaughnessy <br /> First Middle Last <br /> 1265 Bx•acketts Point Road <br /> Address <br /> Wa zata MN 55391 952-935-1722 <br /> �i{y tate Zip Phone <br /> �de� rig d above. <br /> Signature � <br /> F;.ar:,�, .'ti^h r., 4 <br /> � �%t ,�!r..{9fif a.,.��, �• �.'� <br /> 4y;} <br /> ��` �.;�� ''s�t�� � t[ F?.' ''+ i <br /> :i 'i � � ,?+� <br /> ;�;f..YS.r� ,... ;'; �; ` :., ;, i;: <br /> � :rif'.., , .. - � .n' �.,� ti;k. ��� � <br /> a'T�4:�Y ,�. � �,.i'.�.. � :• <br /> 1l: I� ��., �1 Y�.��� <br /> �`%� �I� �i: `�'Kt.r.,��� ti'�Ciiay� ��y�. <br /> ���.� �,�.��� <br />