Laserfiche WebLink
. <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <br /> � _ � e 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 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 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 Iicense. <br /> 3. The information may be shared with other �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 public. <br /> 5. You have certain rights under M.S. 13.04 �o review pri�at� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatiaa or <br /> permit. <br /> �� u � � `� C, I < l� �=" � (, �' � � <br /> First Middle Last <br /> % � � 0 i� 1=� 1 fi�9 G � ,�� � - <br /> Address <br /> ui�v � ��� �� ���>�� .�s- � �l <br /> Cit—y State Zip <br /> �/ �- �� `� S- ,�/ <br /> Phone <br /> I understand my rights as stated above. <br /> . / � <br /> � <br /> -� �i��� �/ ������, <br /> Signa ure <br /> BUILDING&ZONI[YG—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />