Laserfiche WebLink
� - <br /> t t k.i 4 <br /> ����,h� �.. <br /> � � r�� w`�' C ITY of ORONO <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <br /> � - � � 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 /> 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 will 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 /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license 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�at� <br /> data on yourself. <br /> 6. Your full name is required to process this applicatiaa or <br /> permit. <br /> S �� � /�✓ � c:��' / `�"' � �/ /�/ <br /> Firs Middle Last <br /> 1 C' � �-, �G �t R: �'� 1-�-� <br /> Address <br /> ��`/�e: ,z��� �l� ,L- S`S_�=' �i � <br /> City State Zip <br /> �� �.�-- � � ,�-C� <br /> Phone <br /> I understand� my rights as stated above. <br /> , <br /> i <br /> , r <br /> yf " /�j'�_�� — <br /> Signatu�e <br /> �,, <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />