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L <br />DATA PRIVACY ADVISORY <br />In MoordancA with M.S. 13.04, Subd. 2. "Rights of subjects of data”, we wouid tike to inform you <br />that your request for a permit or tioense from the City of Orono or any of its departments may <br />require you to furnish certain private or confkfentiai information. <br />You are notified that: <br />1. The information you furnish witt be used to determine your quaiHication for the permit or <br />tioanse requested. <br />2. You may refose to supply data, but refusal may require that the City deny the permit or <br />Noanse. <br />3. The information may be shared with other local, state or federal agencies to the extent <br />necessary to process th« peonit 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 certain rights under M.S. 13.04 (see following page) to review private data on <br />yourself. <br />6. Your foil name is required to process this application or permit. <br />Firsts Middle Last <br />State Phone <br />410 t rr ^ L <br />M <br />Ii'i .Vi...kAlailM* lAAlak Ji ■ ■t'A Misiinhf.iiitf 11