Laserfiche WebLink
� � <br /> ,�,,.- <br /> ��� ��.��.�`t- <br /> ��-�_ " ����y�� CI'��' O� O�i01\TO <br /> �� � . _.�yt <br /> :� ���:.�rs� . <br /> �` ` �'`��a . Minnesota 55323•Municipal Offices <br /> Post Office Box 66 Crystal Bay, <br /> ! <br /> � _ � � On the North Shore of Lake Minnetonka <br /> DATA PRIVACY 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 /> license f rom 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 /> 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 snared with other local , s�ate or <br /> federal agencies to the extent necessary to process the permit or <br /> I.icense. <br /> 4. If your requested permit or Iicense requires Councii ac��or. <br /> to approve, some information may become public. <br /> S. 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 /> r <br /> �.U � � ��'� � � - �"_. <br /> First <br /> Middle Last <br /> �`� a , /� �r,T� .�� <br /> Address � <br /> / r^.._.. <br /> r.� y <br /> /�]�(/C C� C� �� �—� � �� <br /> City State Z1D <br /> S �� � -7�% OC - <br /> Phone <br /> I understand my rights as stated above. <br /> ��� <br /> % .� <br /> S ' nature <br /> BUILDING&ZONING—473•7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS —473-7359 <br /> ASSESSiN G <br /> �`� <br />