Laserfiche WebLink
��:- <br /> h � F <br /> �9 � 1 . <br /> �� � �` r,� <br /> � �� � i CITY of ORONO <br /> .� . re <br /> "}'�1 yp'Yk-ls.f` ^' .� <br /> S 4M. <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> � <br /> 4 - � � 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 Iike to inform you that your request for a permit or <br /> license 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 /> l. The information you furnish wi3.I 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 license. <br /> 3. The information may be shared with other I.ocal , 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�at� <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> % , � <br /> / �,�. <br /> ;—���CU � � �� � !!.� t1.F�– � ' � ��-��: 6 /�J <br /> First Middle Last <br /> ,� � _ <br /> ���. <br /> l �, ' a �-� �l r��� �,��r- . �)� l3�� ��� / <br /> Address �, <br /> % � I [r� % <br /> i�(r��r. '-�-//'�-�- /�1��� c�J��� f'-; <br /> City State Zip <br /> - �I��� <br /> Phone ' <br /> I understand my rights as stated above. <br /> (��' . <br /> � � � � � � <br /> � �- ,c�i'L,� � � �C. �`� � <br /> Signature. <br /> BUILDING&ZO[YIIYG—473-7357 • ADMINISTRATION&FIN?.I�iCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />