Laserfiche WebLink
- ` ' �`-�'(IPS� C f� ``.? SS <br /> �2 2 - `'d (G� <br /> """,^`u' t�' : G � <br /> yRe.• �4i�..�� ,. <br /> }4Y ���,�X�., �i� �t� O� ���l�l � <br /> ,. �,�s �, <br /> F: <br /> ;��„. <br /> ',:+^�,: <br /> ;"�^�� Post Office Box 66•Crystal Bay.Minnesota 55323•Municipal Offices <br /> " S�.n``a. <br /> 4�f .. <br /> r � _ � � 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 wou3d Iike to inform you that your request for a permit or <br /> license f rom 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 will 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 license. <br /> 3. The information may be shared with other Iocal ► �it or <br /> federal agencies to the extent necessary to process the p <br /> license. <br /> 4. If your reque f�atlon may become public res Councii action <br /> to approve, some i <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6, Yaur ful.I name is required to process this aot,licatiaa o� <br /> permit. <br /> First Middle Last <br /> ,��7� 1�;� �� llr2 <br /> Address <br /> 1� 1.5 t�� �� ti� � - <br /> City State Z1p <br /> ��2- �- � � �'� <br /> Phone <br /> I understand my rights as stated above. <br /> Si natu <br /> BUILDING&ZONING—473-7357 <br /> • ,�.D!�tINISTRATION&FINANCE—473-7358 • PUBLIC WORKS —473-73 <br /> ASSESSING <br />