Laserfiche WebLink
_ � * .. <br /> . � ��� � � <br /> � <br /> ��� ���� ������� ��� CI'�Y of O�iON� <br /> Y x 1:. <br /> � +�i�a <br /> �`'� � � Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal cea <br /> ��� .:r <br /> i •f <br /> � �t' ` ,� �= On the North Sh,ore of Lake Minnetonka <br /> DATA PRIVACY 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 confidential information. <br /> You are notified that: <br /> 1. The information you furnish wil.l be used to determine your <br /> qualification for the permit or Iicense reguested. <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 , 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 Councii action <br /> Ito approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> E. Yc�ur full namP is required to process this apr-licatian or <br /> permit. <br /> ���H A,�u L��� � L � �'"�,L.� ��L%'9 C—�,ti���_�n� <br /> First Middle Last <br /> �� N,�� �; ���,�� '.� < < < <br /> Address <br /> �.o J�JC- �.� i�c� ,�� iy ��� � �� �> <br /> City State Zip <br /> ��� z -- �; � Z �) <br /> Fhone <br /> I understand my rights as stated above. <br /> �4� �-r�� L-Z i-�;/7,� - <br /> Signature T <br /> BUILDING&ZONING—473-7357 • ADMINISTRATIO[Y&FINANCE —473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSIN G <br />