Laserfiche WebLink
_ ��' <br /> ��'��' a� ����T� <br /> ad 7 Posc Office Box 66•Crystal Bay,l�linaesora a�323•Municipal Qffices <br /> aa <br /> _ �!_ �� � �, On the North Sizore of Lake Minnetonka <br /> DATA_PRIVACY A17VISORv <br /> In ac6ordance with M.S. I5.I65, "Rights of subjects of data", we <br /> would �ike to inform you that your request for a permit or Zic�nse <br /> from the City of Orono or any oi its departments may require you to <br /> furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The information you furnish wil.I be used to determine your <br /> qualificat�on for the per.nit or Iicense reauested. <br /> 2. You may re?=use to suppl.y data, but refusa3. may require that <br /> tne City deny the pe�it or Iic�nse. <br /> 3. The inior�ation may be shared with other IocaZ , state or <br /> federal agencies to the estent necessary to process tne pe�it or <br /> Zic�nse. <br /> q, If your reauested pe�-mit or license recuires Counci� acticn <br /> to approve, some infor�nation may become public. <br /> 5. You have certain rignts under M.S. 15.165 to review private <br /> data on yourself. <br /> 6, Your ful.1 name, and date of birth are required to process <br /> this application or permit. <br /> . -.�, _ �y_����.-.�.i:]-1'--------------- --- <br /> l�� C°� �1------ -._. _ -- --------- __-- -�---- --- . . <br /> First <br /> Middle Last <br /> �� j< L �'r�-`f C� ;��k. - -. _ -----. . ._ -- - <br /> Address <br /> T <br /> , - ' <br /> l�-�.��:> .__C��-:._ ---.-� --- --.._._.._._�3�1t�__.--__.. __.----- :-C----�--�- ---- �---�---..._ <br /> City State ZiP <br /> 7�t G � �1 ------- --- -- <br /> Phone , ' <br /> I unde n g s s stated abone. <br /> Si t e - ` <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • P[JBLIC WORKS—473-7359 <br /> ASSESSING � <br /> 5 <br />