Laserfiche WebLink
� ' H � <br /> ��� <br /> �' 4������t ��� <br /> ., .. ...'_�� <br /> .� f . <br /> �� �.:�� . �p.�.�.��� CITY o� �RON(� <br /> � , <br /> '�n`�.� � `� Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> L° a� <br /> fi��- �'���t?�' 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 Iike to inform you that your request for a permit or <br /> Iicense 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 supply data, but refusal may require that <br /> the City deny the permit or 3.icense. <br /> 3. The information may be shared with other �ocal , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Councii a�tion <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 Lo review pri�at� <br /> data on yourself. <br /> E. Your full name is required to process this applicaticn or <br /> permit. <br /> ��., ;� �� �;1,,�.. �� a E= �.� ;i� <br /> First Middle Last <br /> �o2�S (-� �-� \��� �--� ���� <br /> Address <br /> �� ��.. pcc.: � :-�_ � '1�! `� SS�t� - Sc �y <br /> City State Zlp <br /> `"1 `�-� - ��C��'-7 <br /> Phone <br /> I underst nd my rights as stated above. <br /> _ _ � <br /> _ <br /> ` -- �-- <br /> \ � -- . <br /> ignature� <br /> BUILDING&ZONING—473-7357 • AD!�iLtiISTRATIOti&FIti.a.VCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />