Laserfiche WebLink
. a�p�"7�'+�, v <br /> f�� �,w � <br /> ��''��1`�y.=,� . <br /> t � <br /> e ��'` b t'� ��a. ,u�' ,; <br /> � '` �i��Y O� o��N� <br /> t ' s ,; <br /> .�� , � <br /> f ft �� ;:� �},Y <br /> �4.�f ��"YG`� > >'�j ` ;k <br /> �aF ����,�� �.. Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Officea <br /> i;f`'�s-.t", i,:�3> <br /> ��"a��':' .� , <br /> a`-°' �y v�'�'�`° On the North Shore of Lake Minnetonka <br /> �; �: ,-�. <br /> �� � �� ��� DATA_ �RIVACY 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 /> l. The information you furnish will be used to determine your <br /> ����� qualification for the permit or license requested. <br /> ��' ut refusal ma require that <br /> �� 2. You may refuse to supply data, b Y <br /> the City deny the permit or license. <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 /> , <br /> � n , /, <br /> . ( /�. - <br /> � _��?:/` Uf�� __. ..__ � . `,5.�,��"� r� V� <br /> �.J {�� i <br /> - -' <br /> ...._. .. .. .�._____ _. <br /> . __._._._. _.__.....--- - _..._ ___.. . ___._ . <br /> First Midd�e Last <br /> � • , . C� �,�; � �Z�: <br /> _..----- ___ . ._ .._ <br /> � - - �- -�-�- 3 �'- . .... . .__�__......_ _ - �--- -�-----.. ._ - - .- . <br /> Address <br /> y �, . v <br /> J <br /> ��C/.�U'� , /vL� �J,-z%: y�- - - - --- - <br /> � __. _._ _.. . . .. <br /> _ ---_�-- -- --- _ _. .. ._._ .____. -. -- ._ -- _______ _____ _ __ <br /> ...._ <br /> City St�ate ZiP <br /> � t�� , <br /> o� - �- `-� �,-•(.- y_ ___ _- --- --- <br /> _ _. _ ._. ._. .. <br /> Phone <br /> I understand my rights �. :�'�ated above. <br /> � ? _ _._.. . .. _-:'.. ---_ __ ,� �2_. ��'._ t�_�,�-��'- �'. <br /> .. - _ _ _ _ .� . <br /> Signatur <br /> BU[LDING&ZONING—473-7357 • ADMWIST.',�:"''�"� FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> A3SESSING <br />