Laserfiche WebLink
. <br /> . '*. <br /> � � � �r�cq�;r�i <br /> � ������x� 7� GI'�Y O� Ol$ON� <br /> ��`�.��` .� � <br /> �-..����` - ; <br /> -'������ �' <br /> �'�"� H " s Post Office Box 66•Crystal Bay, Minnesota 55323•Municipai Offices <br /> • ""� <br /> • - e � �j µ� On the North Shore 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 /> Iicense 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 /> l. The information you furnish will 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 rocesscthe permit or <br /> federal agencies to the extent necessary to p <br /> 1.icense. <br /> 4. If your requested permit or Iicense requires Councis ac��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 proc�ss this application or <br /> permit. <br /> � - <br /> � (� � � , � � c l � c � � � o <br /> ��� ` Middle Last <br /> First <br /> . <br /> � � � � � � <br /> Address <br /> j�� I� , ,Is � , f t � �' `i <br /> City State Zip <br /> L � L' `)� / � L � S — <br /> Phone <br /> I understand my rights as stated above. <br /> � << � ;�ji � � . <br /> , <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMlNISTRATION&FINANCE —473-7358 <br /> • PUBLIC WORKS—473-7359 <br /> ASSESSIN G <br />