Laserfiche WebLink
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
� I �T. <br /> r � <br /> .. . :♦ _ r;� . <br /> i <br /> , � ' )� <br /> 1 <br /> ` .. `�,��� �eFl�'� <br /> �.Y` �� .�,�'',, +�'�.,$ (�I'1�'�' Of OR011T� <br /> � `' �`��s� „,"g:� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> 0 9 y <br /> ��:^ �.d,..r . <br /> 4r���,����r#�3�`� On the North Shore of Lake Minn.etonka <br /> �`:���� <br /> DATA PRIVACY ADVISORY <br /> In accordance with t�i.S. 15. 165, "Righ�s of subjects of data°' , <br /> 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 <br /> require you to furnish certain private or confidential inform- <br /> ation. <br /> You are notified that: � <br /> 1 . The information you furnish will be used to determine <br /> your qualification for the permit or license requested . <br /> 2 . You may refuse to supply data, but refusal may require <br /> that the City deny the permit or license. <br /> 3 . The information may be shared with other local , state � . <br /> or� federal agencies to the extent necessary to process <br /> the permit or license. <br /> , <br /> 4 . If your requested permit or license reqires council <br /> action to approve, same information may becom� public. <br /> S . Xou have certian rights under M.S . 15. 165 to review <br /> private data on yourself. ' <br /> 6 . Your ful.l. name, and date of birth are reguired to process <br /> this application or permit. <br /> Fir Middle L t <br /> ress ,/ <br /> �y8s �,� - <br /> Date of birth (do�s not apply to buil.ding/gen.eraZ permits) <br /> 7S- �.,:t�L <br /> Phone <br /> I understand my rights as stated above, <br /> X i�� <br /> ignature <br /> BUILDING& ZONING—473•7357 • ADM[NISTRATION&FINANCE—473•7358 • P[IBLIC WORKS—473-7359 <br /> ASSE?SSING <br />