Laserfiche WebLink
� <br /> :� .,'� <br /> - � -f �iONO <br /> CITY of O <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � _ � A ; On the North Shore of Lake Minnetorcka <br /> DATA_ PR�VACY ADVISORY <br /> In accordance with M.S. 15.165, "Rights of subjects of data", we <br /> would like to inform you that your request for a permit or license <br /> from the City of Orono or any of its departments may require you to <br /> 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 Iicense 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 other local, state or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or license requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 15.165 to review private <br /> data on yourself. <br /> 6, Your full name, and date of birth are required to process <br /> this application or permit. <br /> ` , <br /> „ l,(��-e.�_�_e..___ - --�- �1 o6r►-►�.C1.�__s_. �.-- <br /> ���. ►.'i�v _ _ _..--- .._.---�---- - � <br /> First Middle Last <br /> . . . -- --- <br /> _ � 3 3_3 _ . �^._�►.oY.e�_�ri_ c�_ .- ---�='=-.___.__._ _. _ - ---. . _ <br /> Address <br /> '��v���Ye �`��' .�-5 31� -- - <br /> City State Zip <br /> (� � �- -- `r��� �5.��.�._.._..----- <br /> Phone <br /> I understand my rights as stated above. <br /> ! <br /> . <br /> � �' . --�-----.._ -_.. ___..---�---- <br /> ignature' <br /> BUILB[NG&ZONING—473-7357 • ADMINISTRATION 8c FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSI\G <br />