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Fog,ri, 5. _2003 10: 37AM E• lder Jones Permitting No. 0113 P. 1/1 •- .rs:.rr.u�10 . 09/24/96 14:UO Di :03/03 NO:522 • r • Ses.13.04 R1GRTS OF SUJJZcTS Or DATA - Bubd. 1. Typo of data. The rights of individual oo whom the date to-stored or w he stored shall be at set forth In thus sadden. • Subd.a. Information required to be gine IndieldueL An 1»d1v dull anted to supply private or confidential dart eanm.rning himself shall be Into oft (a)the lmrpose and Intended use of the meq:mod data within the eolieoddg tale egeeoy,political subdivision,or saawida system: (b)whither be may refuse or Is legally.required to supply the requested date(cl stay known consignees arising from his supply log or Militias to amply private er eontidenlfal darn.and(d)the identity of other pavans or enddes audrodxad by nate or federal law to receive rho data. This tequireoleut shell • tor,apply when an individual Is asked to supply Invesngadve data.purine to saedarz'l3:82,subdivision S.to a law enforcement officer. . ii.- .Ih.I .i.!J. t e1. u'V Sir I. C L•t ! AL% •t• b• v' I. • _t ti 2 v.• _ :1: •,•=u a. ret ., d044-t b rho r Ebrroc. , . • . Subd.3: Areas to data by individual. Upon.request to a respetnlble aotborlty.an Individual shall be Informed whether ho le the subject of noted den on individuals,and whether it is classified as public.p(ivate or Pot:lldt:ndel. Upon his further requeit,aur individual who Is the subject of stored private or public dui an individuals shall be shown the data without any ebar'ga to hint and.If he desires,shell he informed of the content • and rhtaetog of hu.datrt.. After en individual baa been showo the Ovate data and informed of is meaning.the tits need noe•bs disclosed to.dim for • it zombi thereafter artless a dispute ot.action pursuant to this reeek s in pending or additional dart on the individual has been collected or erased, The'responsible auttprrgr shall provide copies of rbc private or public daa►upon request by the Individuat ed:0a t of the dim. 7he•respoaside authorhy ... ' eery mules the regttesdng person to pay the actual Doom of making.t ettlfybtg.nod oeaeplhos the coptee. The responsible authority.shall comply inuntlfately,if possible,With any request made pursuant to Cis subdivision,or within Ave days of the due of the requou.excluding Saartdeys.Soo41ys and legalholidays,If is diem compliance is not possible. Into cannot comply with the request • ' MAW that dine,he shall as inform the individual,end may have an addltlohal live days within which to comply with the requeat.excluding Saatrdays. Sundays and legal holidays. . . - Subd.4. Procedure when darn is not accurate ea oampler<a. An ladiv4dual nay corm the accureey or completeness of public orprlvare dare eoneenting hImseif. To exorcise this right.en iadWidual shall oailyr in wrldng the responsible wdwt4iy destatbIng the nentn of the dlsagriemone. . The rvsporelbie authority shall within 30 days either. (a)correct as data found to be i s:ccurare or irttamhplem and errempt to notify put recipients of• Ineocumre or Incomplete dura,Including recipients named by the Individual:or(b)eonly rix individual that he believes the dui to be correct Data . - la dispute shell be disclosed only if the individual's statement of dlsagrexrmau la Included with the dlscioeed data. . The determination or the responsible authority may bo appealed pursuant to the provisions of the idntlnisrradve procedure act relating to conrestad cases. . • PT&PRN& YApVISo w • - ` ' - . In aocorda ce with M.S. 13.04,Subd.2,'Rights of aubjectn of dace,', we would like to inform you that your request for a permit or license from the City of Orono or any of its departtnetita 'stay require-you to furnish certain private or confidential ioforination. . You are notified that: - - 1. The information you furnish will be used to determine your qualification for the permit orlioeuao requested. 2. You may refuse to supply.data, bur refusal may require that the City deny the permit or license. 3. The information may be•sbared with other local, state or federal agencies to the extent necessity.to process the permit or license. . • 4. . If your requreted permit or liiceuse requires Cormcil action to approve, some information may become • • public. - • 5. . You have certain righra under M.S. 13.04 (available upon request) to-review private data on yourself. 6. Your MI name is required to process.this application or permit. • • .!�►.&•'. a - AI'-.41. _ A %_,.a siL. • • 116. ; ►i-1,' , l.4_ > - . ibc.— S- .01/7' S V . • Esta Zip S :•as . • ' 1. . and my stated above. • -. • - - • itseature •_