Laserfiche WebLink
� _� <br /> .�-��� <br /> r•� ` - �I�Y of ORON� <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> 0, <br /> ; o _ � A On the North Shore of Lake Minnetonka <br /> � DATA_PRNACY ADVISORY <br /> In accordance with M.S. 15.165, "Rights of subjects of data", we <br /> would like to inform you that your request for a permit or license <br /> from the City of Orono or any of its departments may require you to <br /> . furnish certain private or confidential information. <br /> You are notified that: <br /> l. The information you furnish will be used to• determine your <br /> qualification for the permit or Iicense requested. <br /> 2. You may refuse to supp3.y 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 license requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 15.165 to review private <br /> data on yourself . <br /> 6. Your full name, and date of birth are required to process <br /> this application or permit. <br /> ��./�--5 <br /> � __ .___ . __ __ _ ._ _ _ .______._ __ _ ___ _. <br /> _._._ ______ _. __.____ ___ __ . - <br /> Firs Middle Last <br /> / ____ � �.z.-- <br /> �S y ' , _��" J� ` !1/___�l_.✓--.-- -- - - ---- - <br /> . ._ _ _. _ . .. <br /> __ . _. . .... _ <br /> Address <br /> ._. _ .. ._ _/�.__------- --- - --�--i�!�%L.-.--- ._ __ -- --�---`...��----�/-�_��--------��-- <br /> City State Zip <br /> ���� �c`��---- -- - - --- - <br /> Phone <br /> I understand my rights as stated above. <br /> � �L�� <br /> _ � �- --- _ _---- - ------ --- -------.___ . <br /> i _ � .. . _ <br /> Signa e <br /> BUILDiNG&ZONING—473•7357 • ADMINISTRATION�FINANCE—473-7358 _ • PUBLIC WORKS—473-7359_-'=: <br /> A3SESSING <br />