Laserfiche WebLink
. . . <br /> ��� <br /> .�„ ,3{� ,�.,.,��4 <br /> � � .�o� <br /> �; � ��� <br /> �� �:�? � "� � GI'r�' Of O�iO�TO <br /> .: . � <br /> �k �' Z�'., y�,.'. <br /> t,+ Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> � " �z <br /> '��� � . �-,: <br /> C t.�, 7�,,q�`. ..� <br /> ;.,�`�=' � �.. On tlze 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 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 inf ormation you f urnish wi I 1 be used to determine your <br /> qualification for the permit or license 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 local, s`ate 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 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 /> �:�,;�,, �,� ) �����ti�;� � <br /> First � Middle Last <br /> � _, <br /> � �C�1 v ��Y �'��� � ,��` <br /> Address <br /> �"���1� � � !`� ��S'� ��` <br /> Citp � State Zip <br /> , �_ . ,.. <br /> _ .=�``'�, ``. <br /> Phone <br /> I understa�d-,my rights as S-tate� above. <br /> � _� <br /> , '� �� ��� �� <br /> Signature <br /> BUILDI[YG&ZONING—473-7357 • ADMIN[STRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />