Laserfiche WebLink
- - . �, <br /> :' '-�.,� <br /> ,� - <br /> -,.�,�fx�,z,��� � �,5:° <br /> � ' <br /> y �� . _ <br /> � � k r C�TY of OliON� <br /> � � }����e: <br /> � �.�,�. , � <br /> }�� � �: , : , Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> � � <br /> �� 9 .,J�"`, <br /> ;�, � - ��' 9�'`� On the North Shore of Lake Minnetonka <br /> �' <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 /> license from the City of Orono or any of its departments may require <br /> you to furnish certain private or confidentiaZ 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 process the permit or <br /> license. <br /> 4. if yaur requested permit or Iicense requires Councii action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review prica�� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ` � <br /> `� } �� C:_�%� L:N._� � �'� ��::. ���L-�. � �`� _ <br /> First Middle Last <br /> :; � <br /> _� <br /> �L'��s i�� �_;= , �%� �_ �� ( <br /> Address <br /> � <br /> ���� �-: � � <;�r � ��'�,,� � �� `� ���j�- <br /> �� � � <br /> City ` ' State Zip <br /> k � -� -� �� "�'�`'- <br /> Phone <br /> I understand my rights as stated above. <br /> .. . <br /> _� _ , , <br /> � � <br /> i % - <br /> i'� � � �`�-�;�� <br /> Signature <br /> B�'ILDING&ZOMNG- �373-7357 • ADMINISTRATION&FINt1NCE - 473-7358 • PC'BLIC WORKS -473-7359 <br /> .4SSESSING <br />