Laserfiche WebLink
_ . �. � <br /> mti���z-� <br /> -�sra�.:�+�+ �:i� <br /> ��'�`�,�a�u.��4;w �ITY o� �ROI\TO <br /> .�?ss <br /> � <br /> , <br /> Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> -- Y: '`+`: <br /> � � � � On the North Shore of Lake Minnetorzka <br /> t� ' �r_�. A <br /> DATA__PR_IyACY ADVISOR__ <br /> In accordance with M.S. 15.165, "Rights of subjects of data", we <br /> would like to inform you that your request for a permit or Iicense <br /> from the City of Orono or any of its departments may require you to <br /> 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 Iicense. <br /> 3. The information may be shared with other Iocal , state or <br /> federal agencies to the extent necessary to process the permit or <br /> �a.cense. <br /> 4. If your requested permit or license requires Council action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 15.165 to review private <br /> data on yourself. <br /> 6. Your ful� name, and date of birth are required to process <br /> this application or permit. <br /> . <br /> �- � ' <br /> /�/< -- � L ._/_ -- - <br /> --- -- - --- <br /> ---- - - - - -- ---- - <br /> First <br /> Midd e Last <br /> 2l�� .�o�1z° � � , - _ <br /> Address <br /> �,r�c��.� �� � ��`��--- -�----�--- <br /> __ __-- ------- <br /> _-- <br /> City State Zip <br /> ��'�.�4� ----- - --- <br /> Phone <br /> I understand my rights as stated above. <br /> gn ure <br /> BUILIIIN & NING—473-735� • ADMINISTRATIOh&FINANCE—473-7358 • PUBLIC WORKS —473-7359 <br /> ASSE .'G <br />