Laserfiche WebLink
�� <br /> r <br /> .t�:. � <br /> _' �` <br /> -� ���'�' �� ���L�l'� <br /> � <br /> �� Post Office Box 60•Crystal Bay, Minnesota 5a323•,�iunicipal O{nces <br /> 0 <br /> . a - � g Orz the North Shore of Lake l�finnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. I3.04, Subd. 2 , "Rights of subjects of <br /> data", we would Iike to inform you that your reguest 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 contidential. information. <br /> You are notified that: <br /> l. The iniorination you furnish will be used to determine your <br /> auaiisication for the per•nit or Iicense recuested. <br /> • 2. You r,tay refuse to supply Cata, but re=usal may require that <br /> tne Citv denv the pe �� it or license. <br /> ' 3 . The intormation may be s:�ared with o��er ioca? , s���e or <br /> � f ederal agencies to the ext�nt necessary to process tne pe�-mit or <br /> ?icense. <br /> a. If your requested per:::it or Iicense =ecuires Councii ac�_or_ <br /> to aDDrove, some inior.^.tation may become pu�?ic. <br /> � . You have cer�ain rignts under M.S. 1� . C4 to rev_zw gr=-rate <br /> data on yourself. <br /> . 6. Your ful.I. name is required to proc�ss th�s appl.ication or <br /> pe*:nit. <br /> /' � ` <br /> i <<r'�/� l l°1 ' <br /> Fi st iddle Las� " <br /> �s�� � � � � � � <br /> Addr ss <br /> � � , <br /> � (�'� 1 �2��'� �Z,/r . <br /> Cit State Zip <br /> �/���'�.� �' 7 <br /> Pho en <br /> • I understand my rights as stated above. <br /> `' 'i� ! <br /> ,�L, <br /> � Signa ure . � � <br /> , <br /> :} <br /> i <br /> 1LDIVG& ZONI`G - 473-7357 • ;�D.ti11NISTRAT10N& FNANCE - 473-73:3 • PUBLIC tivqRhS --t73-73�9 i <br /> ASSESSlY G <br />