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it *' <br />DATA PRIVACY ADVISORY <br />In accontence writh M.8.13.04, Subd. 2. IRights of sut^ects 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 furnish certain private or confidential information. <br />You are notified that; <br />1. The information you furnish will be used to determine your quaiification for the permit or <br />license requested. <br />2. You may refuse to supply data, but refusal may require that the City deny the permit or <br />license. <br />3. The informetion may be shared with other local, state or federal agencies to the extent <br />necessary to process the permit or Hcense. <br />4. If your requested permit or license requires Council action to approve, some information <br />may become public. <br />5. You have certain 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 ttiis application cr permit. <br />•________AI lien _____(^IKf <br />First I D/ miMiddle Last <br />Address ■ <br />city <br />ma/ <br />state Phone <br />-• f- - <br />o <br />i