Laserfiche WebLink
,^� �- <br /> �x�} ���,�.��:� CITY of ORONO <br /> t � .�..� <br /> �,,. � ,r � - <br /> ° '"�- " �; s �w Posc Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> _,,:�-r�.. . ���. _ <br /> 3' .p. <br /> {. s - ,� � On the North Shore of Lake Minnetonka <br /> DATA PRIVACY AD�7ISORY <br /> In accordance with M.S. 13.04, Subd. 2 , "Rights of subjects of <br /> data", we would 3ike to inform you that your request for a permit or <br /> I.icense 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 /> 1. The information you furnish will. be used to determine your <br /> qualification for the permit or Iicense requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or I.icense. <br /> 3. The information may be shared with other iocal , 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 Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> 1 i � �l,�/'�i�n�`�✓Z <br /> L?���; D� � � �% <br /> First Middle Last <br /> �� � c� �G� � -����� <br /> Address <br /> �i�,��� y 2� 7f� j1'7 i �ti'Jv�>:: �i�� �'.5 3 �i / <br /> City State Zip <br /> �j �7 s- l� i �� � <br /> Phone <br /> I understand my rights as stated above. <br /> � � <br /> ��� � <br /> Signature <br /> BUILDING&ZOfYING—473-7357 • ADMINISTRATION&.FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />