Laserfiche WebLink
� • � 1�:-17,'y� 1�=t:�� THE C I TY CiF Li��OFJ[i r,1�-4"� "^�^ <br /> �.�-�._,._�r i_a=t� <br /> � <br /> �i��� O� ����� <br /> �ost Oftice �ox S6•(:ryatai t3ay,Minneeota 6�323•Municipnl OlGtee <br /> • <br /> � .. � � On the Ncirth Shore of Lake Mirtneionka <br /> DATA PRIV'ACY AbVIS�RY <br /> Zn accordance with M.B. �3.04 , Subd- 2, "Rights of S11bjECtS of <br /> data", we would 3ike to inform you that your request for � perm�t or <br /> licerise from the City of. Orono or any of its departments may requi.re <br /> you tio furnish certain �rivatc or conf�dentiial inf�rmation. <br /> You are noti.fied tha�: <br /> 1. 'r}ie information you furnish will be uAsd to dP�:ermine your <br /> qualifiCation for the permit or licens� rec�t�ested. <br /> 2. You may refuse to supply data, bu� refusa�. may Xequire that <br /> the City deny thc pez�m�.t or lic'ense. <br /> 3. The information may b� shared with other Xoca3. , state or <br /> tederal agencie5 to the ex�ent necessary to process the p�rmi.t �r <br /> 1.icense. <br /> 4. If your reqUested permit or xicense r�quirea Council, action <br /> to approve, some informat�.on may bec�me public. <br /> 5. You have certa�.n rights under M.S. 13.04 to zeview priva�e <br /> data on yourself. <br /> 6. Your full, riam� is requ�.red to process this application or <br /> permi.t. <br /> 'So`.,�.- cc� �-ic_�Sa.� - <br /> First Middle Last <br /> �So2 -�Ba,�o��i ve <br /> Address <br /> i <br /> (,�/io ,.�_�i/�'l�/. SS7ZS <br /> City State Zip <br /> 73/�3�5'3 <br /> Phone <br /> I undetsLand my ri ts as stated above_ <br /> - c�a <br /> Sig � re <br /> BUlLDtNG& ZONING- 471-7357 • ADMINISTRnTIon&FINArvcE- a�3•�asa • rus4rc wURxs -a�s•�359 <br /> ASSESSING <br />