Laserfiche WebLink
� <br /> � < -;r <br /> - r,',,�� ,r�� �R.,,,;-�'i <br /> :r; �-t <br /> i y ! ; <br /> � S r r�` - � CITY of ORONO <br /> , �,�, � � <br /> � �tt Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> b f.1.'..�.: <br /> 4Ykd ' 1 <br /> �'�"��`'�"°�`�� On the North Shore of Lake Minnetonka <br /> _.� • s <br /> DATA PRNACY 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 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 shared with other iocal , state or <br /> federal agencies to the extent necessary to �irocess the permit or <br /> license. <br /> 4. If your requested permit or license requires Councii. action <br /> to approve, some information may become public. <br /> 5. You have certain rights sr.der M.S. 13.04 �o review pri�a�� <br /> data on yourself. <br /> E. Your full name is requirect to process this applica�icn or <br /> permit. <br /> �� � � �` �� � G�-� .� _. <br /> First Middle Last <br /> � <br /> �C."_� t ��c'.-�L �' -�z� ' � L — <br /> Address <br /> [ ` � l., <br /> ;; �, ��;���i � 'S <br /> City State Zip <br /> , I� l� - 7 ' `��' <br /> �; <br /> Phone <br /> I understand my right�. as stated above. <br /> r� � <br /> Lc�._- - <br /> Signature <br /> BUILD[NG&ZONING—473-7357 • ADMIN[STRATION&FIVA.tiCE —473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />