Laserfiche WebLink
� <br /> V <br /> r 1 <br /> �*..:t.�i��M <br /> �`��� ` C�'�Y o� OR�IIOTO <br /> , },; <br /> `�.� __ <br /> ��: ��, <br /> Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> ! <br /> � _ � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY 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 /> 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 wil.l 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 /> license. <br /> 4. If your requested permit or Iicense requires Councii. ac�ior. <br /> to approve, some information may become public. <br /> 5. 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 appl.ication or <br /> permit. <br /> i <br /> ' , ���;�� � � . <br /> '�j�l�,'Z, � �, �_��� <br /> � I <br /> First Middle Last <br /> �� �l � � �/������ �� i� � L�.� i.�� <br /> Address <br /> � � �� �-,_ / <br /> � �' 1 � � r� 4 � �� � ��� ' ' � �" �f <br /> City State Z1p <br /> � �-� � --E. c- .� �j <br /> Phone <br /> I understand�.�ny rights as stated above. <br /> � / � 1\ J�� <br /> � �, �--�,�,> _ <br /> Signature <br /> BUILDING& ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />