Laserfiche WebLink
� <br /> CITY of ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea <br /> • <br /> � � � � On the North Shore of Lake Minnetonka <br /> DATA PRNAC3C ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would 3ike 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 thaL <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 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 privat� <br /> data on yourself. <br /> 6. Yc,ur full name is required to process this applicatian oi <br /> permit. <br /> Co.,/ ,o/��r� ���J•,��-'�✓�%,� <br /> First Middle Last <br /> � � �f0 S �/�„�/' /�9 �/o. <br /> Address <br /> /��y,,^o�.-r/a ,�,� SS�41 <br /> City State Zip <br /> Ss�� 9�'� <br /> Phone <br /> I underst d my rights as stated above. <br /> Signature <br /> i <br /> BUILDING&ZONING-473-735� � ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS -473-7359 � <br /> pSSESSING ` , <br /> � <br />