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, . <br /> CITY of ORONO <br /> an p4(-it tifrow 66 Crystal Eil'J,Nirot41 5Ct9i.'-i."`54i+M ,t;'._ cit f'. <br /> • OF <br /> r„ <br /> ORONO On the. North .Share of£';�. e in tanka <br /> DATA PRIVACY r DVI SORY <br /> Tn accordance with M .. 13.04 , ai. bd. 2 , "Rights of subjects of <br /> data" , we woti1d like to inform you that your request for a permit cf <br /> license f rcrl 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 your furnish wikl be used to determine your <br /> qualification for the permit or license requested. <br /> 2, You may refuse to supply data, but re£usai ray require that <br /> the City deny the permit or license. <br /> 3. Tha information may be shared with other local , state or <br /> Federal agencies to the extent r pessary to process the peen t OZ <br /> license. <br /> 4, It your requested perm4t or license r q°U±res Council action <br /> to approve, some information may become tubiic. <br /> 5. You have certain rights under m.S. 13.04 to, review pr Y ata <br /> data on yourself. <br /> 6. Your full nam ' is required to process this apzli+cati`_6 � <br /> p e rn i . <br /> First Middle Last <br /> address <br /> 14 • <br /> tf raur!r' R ff kr Y fir' 'dYrj <br /> • <br /> City State z p <br /> 7 i <br /> I landrtand ." f tcight as .stated above <br /> f m i s <br /> i i <br /> r § 2 G- ,17 : W F V4,-0 C; 145 ;'`E- ;F <br />