Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
� <br /> � *,34�v k�k.�1 <br /> '` 9 � �N"' <br /> .v���� �.�t $C �/���. <br /> � <br /> � � �I'T'�' O� ����Tt� <br /> a. �_.�=s�„ �' �,; <br /> :.1� a+;{ �,-,"i 1�.i�. <br /> t � ��'s <br /> �� 4q � `���"r�� Post Office Box 66•Crystal Bay, Minnesota a�323•Municipal Otfices <br /> � <br /> � _ � �, On the North Shore of Lake Minnetonka <br /> r <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2 , "Rights of subjects of <br /> data" , we would like 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 confidentia3. information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your <br /> aualification for the permit or I.icense requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or license. <br /> 3. The iniormation may be shared with oth=�r esscthe p rmit or <br /> federal. agencies to the extent necessary to p <br /> license. <br /> g, If your 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 pri�a�� <br /> data on yourself. <br /> 6. Your ful.l name is required to process this applicaticn or <br /> permit. <br /> .���-�� C�.. �<<�a� ����n- <br /> First <br /> riiddle Last <br /> � -� � �,�N�� -�%�-P.�%' <br /> Address <br /> � C'���,S'� �✓� �' n' �.� .?.;� / <br /> City � State Zip <br /> � �y- /���-�/ <br /> P:�one <br /> _ ....___ <br /> I un�stand �- ri hts as ated above. <br /> / <br /> / � ' �` <br /> ! � <br /> Sig tu J <br /> � <br /> BUILDI:YG&ZOtiI�lG— ;73-7357 <br /> • ADMINISTRATION&FINANCE —473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSIN G <br />