Laserfiche WebLink
C ITY of OR01�T0 <br /> Post Office Box 66•Cryatal Bay,Minneeota 55323•Municipal Officee <br /> • <br /> � . � � On the North Shore of Lake Minnetonka <br /> � . ��q����_C�.�iDVISORY � <br /> In accordance with M.S. 15.165, "Rights of subjects of data", we <br /> would Iike to inform you that your request for a permit or license <br /> from the City of Orono or any of its departments may require you to <br /> furnish certain private or confidentia�� information. <br /> You are notif ied 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 refusaZ may require that <br /> the City deny the permit or license. <br /> 3. The information may be shared with other local, state or <br /> federal agencies to the extent necessary to process the permit or <br /> . Zicense. � <br /> 4. If your requested permit or license requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 15.165 to review private <br /> • data on yourself. <br /> 6. Your full name, and date of birth are required to process <br /> ., this application or permit. <br /> ... .. ..._...------- -- ----._._.... .----�- - - ----- ----- �---- - ---.._--- �- _ __._._ <br /> -- -•- -- <br /> First Middle Last <br /> ___------- ..__.._... __.._._ . . . <br /> Address <br /> --.._. ....--- -- ._._--- ------ --- -_...._.. ._. ._._. ---.-._.. .._-�-------�------------..._ --- -- <br /> City State Zip <br /> Phone <br /> I understand my rights as stated above. <br /> gnature <br /> BUILDING dE ZONING—473-7357 • ADMINISTRATION�FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />