Laserfiche WebLink
! <br /> . . <br />� f <br />; <br /> i <br /> � � ���� o� ����� <br /> M� <br /> . post Office Box 6&•Crystal Bay,Minaesota 5a323•Municipal Offices <br /> ! _ <br /> On the North Shore of Lake Minneton a <br /> • ' • • <br /> DATA PRSVACY A��SORY <br /> Subd. 2, "Rights of subjects of <br /> In accordance with M.S. 13.04 , our re uest for a permit or <br /> data" , we would like to inform you thof its departments may require <br /> license from the City of Orono or any � n=o�ation. <br /> you to rurnish certain private or confidential <br /> you are notified that: <br /> i. The inTormation you furnish will be used to determine your <br /> cua?i��ca��on for the pe=�i� or license requested. <br /> 2. You may refuse to supply data, but refusal may require tnat <br /> tne City deny the permit or Iicense. <br /> 3 . The information may be snared with otheY Ioca1 , e�ie o�r <br /> f ederal agencies to the extent necessary to process the p <br /> ?icense. <br /> a. _f your recuested pe=�Ttit or license reQulr=s Councis. a��'-or <br /> to aporove, some in=ormation may <br /> become public. <br /> � , You have certain rights under M.S. 13 .Oa to review priv��e <br /> data on yourself. <br /> 6 , Your full name is required to proc�ss t:iS �ppl-����=or. or <br /> pe�it. <br /> � � �� <br /> �N/�i S Last <br /> r^i?"s� <br /> Middle <br /> a�v C N�� L- <br /> F,ddress <br /> GUNc � �„' J��J` �� <br /> City <br /> State Zip <br /> g�� '���� <br /> Phone <br /> I understand my rights as stated above. <br /> � . <br /> J� � <br /> Signature � <br /> BUILDING&ZOYING-473-i 357 • ADMINISTRATION&FINANCE-473-7358 <br /> • PUBLIC WORKS-4�3-�359 <br /> ASSESSIN G <br />