Laserfiche WebLink
- ' � <br /> ��., <br /> , <br /> ��, � .�'�� ..::. x-�*� <br /> ,� �,��� ..� � <br /> •t :9�6?�V �: <br /> � �- � 34 ���:�� ��T� o� oRoNo <br /> V_ __ i= : _7 <br /> ,� j <br /> ��.���''��� f Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> : , <br /> r'`�`':���i�., ,s;,,.:::,.,1 <br /> , �,��fi ���:,r� a <br /> '�''��' � � On the Nortiz Shore of Lake Minnetonka <br /> t a ���� ��" <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 /> 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 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 , s�a}e or <br /> federal agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense requires Councii. act�or. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> Z�. �7�� /���-• <br /> First Middle Last � <br /> �?5� �� S-f�ee'�-�-- <br /> Address ' <br /> r�., G�� ��v ss3 s� <br /> City State Zip <br /> �?S. 2�7(� <br /> Phone <br /> I understand my rights as stated above. <br /> tur <br /> BUILDING&ZONING- 473-7357 • ADMINISTRAT[ON& FINANCE - 473-7358 • PUBLIC WORKS -473-7359 <br /> ASSESSIN G <br />