Laserfiche WebLink
, � �_ <br /> ti � <br /> cITY o� oRONo <br /> Post Office Box 66•Crystal Bay,Minneaota 55323•Municipal Officee <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 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 wi31 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 /> Iicense. <br /> 4. If your requested permit or 3icense requires Counci3. action <br /> to approve, some information may become publ.ic. <br /> 5. You have certain rights under M.S. 13.04 to review pri�ate <br /> data on yourself. <br /> 6. Your full name is required to process this applicatian or <br /> permit. <br /> �^' �y� � %h� <" <br /> First Mi d e Last <br /> ,,�S3S %���i �r;e �' _ <br /> Addr ss <br /> o� �� S� <br /> City State Zip <br /> ��/ - ��3 � <br /> Phone <br /> I understand my rights as stated above. <br /> . � <br /> Signature , <br /> BUILDING&ZONING-473-7357 • . ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING = <br />