Laserfiche WebLink
., <br /> �� <br /> � ��'�r�- �. <br /> �� � �I'��' O� O�ON� <br /> `y'i � � <br /> Z..•: <br /> . �$�.• <br /> � °="`�" Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> �� <br /> • "��.-., <br /> � _ � T'�` 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 /> 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 /> l. 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�ate or <br /> f ederal agencies to the extent necessary to process the permit or <br /> I.icense. <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 procsss this application or <br /> permit. <br /> !� ,/ `, <br /> ��_-� '`- l'� ' <br /> � � '' ���-1 ` <br /> Middle Last <br /> First � <br /> L `r1� - � - " � <br /> Address <br /> '� L- <br /> �'' � t.` �5 > C. <br /> � ��r�� � .. �� <br /> C ' ty State Zip <br /> �/1� ' '� (�'� C� <br /> Phone <br /> I understand my rights as stated above. <br /> �� _� J <br /> �.��� 'L� �� ��-� , <br /> ignature � <br /> BUILDING&ZONING-473-7357 <br /> • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS -473-7359 <br /> ASSESSIN G <br />