Laserfiche WebLink
�.,.._� <br /> �- � �� <br /> �..� �^`.��� , . ,,� _F� <br /> ���, <br /> � ._� <br /> � �� �'� k `� CITY of ��0�� <br /> �� ��- . �_� <br /> a�c <br /> �,�, ;,, � � *j Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> ��si�'�` _ <br /> �.�R �a <br /> --��,Y��a. � <br /> �'�"� ��j� �-;' 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 3.ike to inform you that your request for a permit or <br /> I.icense 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 wiZl 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 ioca? , 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 Counci� action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 �o review pri�a�e <br /> data on yourself. <br /> E. Your full name is required to process this application or <br /> permit. <br /> � ��.� <br /> n <br /> �l, :�' L/�-�l� � ,� � , � , <br /> First ;; . � iddle �, � Las�t ` <br /> � i / ';�� �' .���'l ; _(`� o k�. l���t� l 1/ <br /> Address <br /> �� • , ,. / —;-- � <br /> � G�(.�i�a,( � �I � 1 J `-'`� � � � <br /> City State Zip <br /> 7 �� �- ���� � �. <br /> Phone <br /> I understand my rights as stated above. <br /> �� r <br /> �_ � � <br /> � � f� � <br /> /L �""` j' ` ��`' � � � <br /> Sig a e <br /> BUILDING& ZONING—473-7357 • ADM!!�'ISTRATION& F[NANCE —�373-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />