Laserfiche WebLink
CITY ®f ORONO <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> a - ® On the No th Shore of Lake Minnetonka <br /> DATA PR ADVISORY <br /> In accordance with M.S. 13. 4, Subd. 2, "Rights of subjects of <br /> data", we would like to inform y u that your request for a permit or <br /> license from the City of Orono o 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 furs <br /> h will be used to determine your <br /> qualification for the permit r 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 hared with other local, state or <br /> federal agencies to the exten necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Council action <br /> to approve, some information ay become public. <br /> 5. You have certain rights nder M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is requir d to process this application or <br /> permit. <br /> v ma 5 <br /> First Middle Last <br /> Address <br /> MA,) 55-3 5 <br /> City State Zip <br /> '-/7 G{ -ZZ 5G <br /> Phone <br /> I understand my rights as state above. <br /> 6A,�L /4 - <br /> l0 wY <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&IFINANCE—473-7358 PUBLIC WORKS—473-7359 <br /> ASSESSING <br />