Laserfiche WebLink
:�r����;�: <br /> {���.�r '� <br /> � i�7'2"',rn�� F y .ri�k. , <br /> Iy^ <br /> �:- f e.'.`.S." <br /> � ���x � r �K:�, .:� �ITY o� OROloT� <br /> ��� _ <br /> „j,.'� �� �'� �>- Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> ��3 � <br /> Tr�&� ';`�*��� <br /> r "#'� On the North Shore of Lake Minnetonka <br /> :�: , � s <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of <br /> data", we would Iike to inform you that your request for a permit or <br /> license 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 /> 1. The information you furnish will be used to determine your <br /> qualification for the permit or license requested. <br /> 2. You may refuse to supp�y data, but refusal may require that <br /> the City deny the permit ar license. <br /> 3. The information may be shared with other Iocal , state or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense reasires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights ander M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Yaur full name is required to process this apr,licatica or <br /> permit. <br /> ) � � �� � ^�� <br /> - �. � . �.� � � � QO <br /> First Middle Last <br /> ._ _ � <br /> _ - <br /> - ���- � / C � ���- S �:� � ( ��' c � C_ <br /> Address <br /> �_ , <br /> __��__ `, �. , <br /> % ,�� `��� s� c� }��"�'-) ��_�� e> > � l � <br /> City State Zip <br /> ���/ �;;' �'"�.`�I�� <br /> Phone <br /> I understand my righ as stated above. <br /> �� � � � <br /> Signature / <br /> � <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSI�YG <br />