Laserfiche WebLink
� <br /> C I�Y of ORONO <br /> Post Office Box 66•Crystal Bay,Minne,sota 55323•Municipal Officea <br /> a <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 /> Iicense 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 l.icense 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 Council action <br /> to approve, some information may become publ.ic. <br /> 5. You have certain rights under M.B. 13.04 to review priva�e <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> /�,¢n�'� y ✓.,%�v� ,������./ - <br /> First Middle Last <br /> /70 9 /�/�� ,�',��r�I /�i� <br /> Address <br /> �a�G1 G4/Zc ��✓ �.���o <br /> City State Zip <br /> `�'j� - y�� <br /> Phone <br /> I understand my rights as stated above. <br /> Signa ure <br /> BUILDING&ZONING-473-7357 • ADMINISTRATION.�FINANCE-473-7358 • PUBLIC WORKS-473-7359 <br /> ASSESSING <br />