Laserfiche WebLink
��4f�'���Tk _ <br /> �!'`�` .L d'��r��.r , <br /> t �,. ��+T�` f r �..:'. <br /> a.az;ad"a �a �, s 7 . <br /> G���f������f�`�:� CITY o� OIiONO <br /> �_.,;}�N�f.�_� <br /> ��'.ti..,.�,c�f,,,�:�' <br /> ��`�-; Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> h��� 'i�Q'"Y`j�:'�.., .. <br /> � � ��� <br /> Yy: <br /> Y ,-F": On the North Shore of Lake Minnetonka <br /> v - • ��::- <br /> � DATA__PRIVACY 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 /> 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 �icense. <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 /> Zicense. <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 /> /�����'�',f� ,Gv�C-�S � � - -- - - - <br /> First ���� Middle Last <br /> --�"�- .`�- `.�t�. .___ _---- .. . _ -_ -�-'�----�"�-.--.--�___.__._ .. ._ __ ----_ . ._ . ..___ <br /> Address <br /> ��CL_'��_-�_ __GD�-- - ._._..___`�-.-- -- -S�S3��--- ._.-----�-- <br /> City State Zip <br /> . <br /> _h�7�_._�_7_.�-__r__�_.___.___ .__.__ _...---------- <br /> Phone <br /> I understand my rights as stated above. <br /> -------__. .___ ..-----.--__ . <br /> Signature <br /> BUILBiNG�ZONING—473-7357 • ADMINISTRATION�FINANCE—473-7358 • PUBLIC WORKS-473-7359 <br /> A3SESSING <br />