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WITT <br />DATA PRIVACY ADVISORY <br />In Acoontonoe with M.S. 13.04. Subd. 2, "Rights of subjects of data", we would like to inform you <br />that your request for a permit or license from the City of Orono or any of its departments may <br />require you to ftimish certain private or confidential information. <br />You are notified that <br />1. The information you ftimish will be used to determine your qualification for the permit or <br />license requested. <br />2. You may refiise to supply data, but refusal may require that the City deny the permit or <br />license. <br />3. The information may be shared with other local, state or federal agencies to the extent <br />necessary to process the permft or license. <br />4. If your requested permit or license requires Council action to approve, some information <br />may become public. <br />5. You have owtain rights under M.S. 13.04 (see following page) to review private data on <br />yourself. <br />6. Your full name is required to process this application or permit <br />/ • <br />First _, , Middle <br />Address <br />Last <br />AH/______ <br />CNy State Phone <br />V* •Jj <br />.i^»* t i.' •. <br />I A- tatew^ w