Laserfiche WebLink
r4 <br /> � �� �,�ks� ���: x <br /> .���':a _.�. �;;. <br /> �. <br /> �i ��: `� ` CITY o� O�ONO <br /> i s a .�� -: <br /> n� �a",;��^ ..v: <br /> _s...__+��. <br /> E{n.e s.u��:++ ' <br /> •;"4a':�'S�_.�:3tl'. : <br /> , �,�, Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> :;��. <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 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. �T�ne informazion you furnisn 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 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 /> license. <br /> 4. If your requested permit or Iicense requires Council action <br /> to apprave, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pricat� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ��� ��� � 1; e� I���i ��'�"�r� -- <br /> First Middle Last <br /> � � � � C � �Sfi� � P� ��_(�� <br /> Address <br /> �+.i�%t 1/ �t�.�`n �"✓� b�; � � � � � <br /> City T State Zip <br /> '� � I �? `� �7 1 <br /> Phone <br /> I understand my rights as stated above. <br /> ����� <br /> Signat e <br /> i <br /> BUILDING&ZONING—473-7357 • ADMIN[STRATION&FINANCE—473-7358 • PUBLIC WORKS —473-7359 � <br /> ASSESSING � <br /> � <br />