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o <br /> `�. CITY of ORONO' <br /> MhokipdOMM <br /> ,; �'��� �F Foe Oaks Bac 66 <br /> �A �� G Cry�taiBay,bHmeaaa5 0066 <br /> A r Og� <br /> DATA PRIVACY ADVISORY <br /> In accordance with'M.S. 13.04, Subd: 2, "Rights of subjects of data", we would lime to <br /> inform you that your request for a permit or license from, the City. of Orono or any,of:its, <br /> departments may require 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 qualification for the <br /> permit'or•license requested. <br /> 2. You may refuse'to supply data, but refusal may require..that the City-deny the <br /> permit or license. <br /> 3. The information may be shared with other local, state or federal agencies,to,the <br /> extent necessary to process the permit or license. <br /> 4. If `your requested permit or license requires Council action to approve, some. <br /> information may become`public. <br /> 5. You have certain rights under M.S. 13.04 (see following page) to review private <br /> data on yourself. i. <br /> 6. `Your full name is required to process this application or permit: <br /> PLEASE PRINT <br /> James N. Jensen (Jensen Hanes, Inc. ) <br /> First Middle Last <br /> 601 Carlsoiv-Parkvvay,-Suite 1225 <br /> Address <br /> :: :MUnnet onka,% BBV 55305 (612), 475-0548 <br /> City' State Zip- Phone <br /> I unders `my rights as'stated above. <br /> Signature <br /> TE.BMNE-4r3-7357•FAX-4734MO <br /> 10 <br />