Laserfiche WebLink
' . ,�_ <br /> ��'��='� � `�` - <br /> x ?;r ar � � <br /> �.� ,� � ��:.,, �i��� O� ���1�'� <br /> ,#.. <br /> ,. A'.� .��-.�-_. <br /> �.�� ��.- <br /> _ _ .,.� <br /> '� �'``�"'"- Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> a <br /> � � - � . � On the North Shore 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 3.ike to inform you that your request for a permit or <br /> l.icense from the City of Orono or any of its departments may require <br /> you to furnish certain private or confidentiaZ information. <br /> You are notified that: <br /> l. The information you furnish wil.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 Iocal , s`ate or <br /> federal agencies to the extent necessary to process the permit or <br /> I.icense. <br /> 4. If your requested permit or Iicense requires Councii ac�ior. <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 /> '�1C.(.C A-H( �� /�;��Ct�/�/L.1/�l <br /> First Middle Last � <br /> l'C"i�� �G�-ll�- L�r�.�l.��l- ,4�vG=. - <br /> Address <br /> l�'�C3 U./J�a /`'�/� � �f� �'-7 <br /> City State Zip <br /> �,C��� �1"(,C% <br /> Phone <br /> I understand my rights as stated above. <br /> �� ?. �/_ ����c_���-�> <br /> �.���c��, f�.� � -� _ <br /> Signature <br /> BUILDING&ZONING—473-7357 • ADMINISTRATIOIV&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />