Laserfiche WebLink
� <br /> .,.�--� <br /> h .,w'MF� <br /> �M <br /> {1rtrM^sri+Y. 'S'R <br /> Ft�'..r� �.w ,,,�>'.'' <br /> ',a�r�� � �:�: _w <br /> ��:���`�'q��y -�.�����:` �i�'�'�' Of 0��1�� <br /> ��y3'1 G�`��`1l �'.J' .h:.. <br /> f.F `'t�� v�� '+�t.;,` <br /> % �' �,���,��,.,,- Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> '� : _�F" <br /> � .a, <br /> �'�� y`�4 On the North Shore of Lake Minnetonka <br /> , � - �� � �_. <br /> x <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 /> 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 /> 1. The information you furnish wil.l 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 snared with other local , s�a�e 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 ac��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 �o process this application or <br /> permit. <br /> i�E-rt K c�-�F>r��y��c��t�s �'�I�uF«. <br /> First Middle Last <br /> �l�f,c_l �-`)��f�4�0 �Ut" , <br /> Address <br /> �"� <'t,�L �/U%�_ l`-f�.1 `->S�3/ <br /> City State Zip <br /> �/��- l�� <br /> Phone <br /> I understan rights as stated above. <br /> Si nature <br /> BUILDING& ZONING— 473-7357 • ADhfINISTRATION&F[NANCE - -t%3-7358 • PUBLIC WORKS —473-7359 <br /> ASSESSING - <br />