Laserfiche WebLink
_ � � . <br /> _ "``,��. � <br /> ^::Y CI'��i' o� OR�I�O <br /> � <br /> t.. µs <br /> i Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <br /> � . � o On the North Sh.ore of Lake Minnetonka <br /> DATA PRNACY 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 wil3 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 Iicense. <br /> 3. The information may be shared with ot�o esscthe ermit or <br /> federal agencies to the extent necessary to p P <br /> license. <br /> 4. If your requested permit or Iicense requires Councii act�or. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to procass this application or <br /> permit. <br /> ��� .�j��L i�c I C �- <br /> �` �` � � Last <br /> First Middle <br /> ;' : _" =� ) ._c t�`-= � C �fi_ <br /> Address <br /> �(-� l< �� 1 � ( � l�7>L -= j�, `� � <br /> City State Zip <br /> � -���� c : J��� — � .�c_- l <br /> Phone <br /> I understand my rights as stated above. <br /> �l "� <br /> / � ' <br /> <<-`�� ���' `'-�'�' �`, <br /> Signature . � <br /> BUILD[NG&ZONING—473-7357 • ADMINISTRATION&FINANCE--373•7358 � PUBLIC WORKS —473-7359 <br /> ASSESSING <br />