Laserfiche WebLink
f.. � �'�;�m�.ir <br /> t '�.�1�`h �.. <br /> .� �� �� �. � - �- Ci�'��' O� o��N� <br /> � � f�. �� �� <br /> , <br /> r,4'.Y%lc.,..2t1f�Iz,:����':i. <br /> =' � Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> • <br /> � - � ,�: On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would 3ike 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 license 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 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 Iicense requires Council 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 application or <br /> permit. <br /> . <br /> �ft�Y ,�E� J�.s,�,Qsk � . <br /> First Middle Last <br /> ,.Sr35�� ' �'�£ � <br /> Address <br /> ��►�,,� �,� ss�19 <br /> City State Zip <br /> 82 3 - �v�29 <br /> Phone <br /> I understand my right stated above. <br /> Sign r <br /> BUILDING&ZOIYING—473-7357 • ADMINISTRAT[ON&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />