Laserfiche WebLink
� . �C <br /> Md <br /> �;� > <br /> � �t�_ 1�` t ' <br /> t <br /> .^+. � �b <br /> � -� t � ��� �, �T CITY of ORONO <br /> � F . <br /> �_� � <br /> �'� " �' � Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> u ;� . <br /> �� �r �� <br /> � _ .�� ��� : On tJxe 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 /> ].icense 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 wi3.1 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 iocal , state or <br /> federa3. agencies to the extent necessary to process the permit or <br /> 3icense. <br /> 4. If your requested permit or Iicense requires Councii 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 applicatian or <br /> permit. <br /> �,.� � , i�E��� <br /> First Middle Last <br /> l�`� �z�� � r.��. <br /> _ � <br /> Address <br /> �t��n.�,.. M rJ ��i ��k� <br /> Ci—y State Zip <br /> ��7� ' � � �� <br /> Phone <br /> I understand my rights as stated above. <br /> �� <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • P[,'BLIC WORKS—473-7359 <br /> ASSESSING <br />