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s <br />•• ;% <br />1 <br />I/O GITYof ORONO <br />Mnnldpal Offices <br />StmlMdrass: <br />2750 IWicy Paitany <br />Oronoi MN 55356 <br />MaiUBg Uinta: <br />P.O. e« 66 <br />CiysUI Bay. MN 55323-0066 <br />DATA PRIVArV ADVISORY <br />In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to <br />inform you that your request for a permit or license from the City of Orono or any of its <br />departments may 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 qualification for the <br />permit or license requested. <br />2.You may refuse to supply data, but refusal may require that the City deny the <br />permit or license. <br />3.The information may be shared with other local, state or federal agencies to the <br />extent necessary to process the permit or license. <br />4.If your requested permit or license requires Council action to approve, some <br />information may b^ome public. <br />5.You have certain rights under M.S. 13.04 (see following page) to review private <br />data on yourself. <br />6. Your full name is required to process this application or permit. <br />First Middle Last <br />T^eoe.ioptYV;r\.4- LLC Pr:)\Qrr,s LAY\e <br />Address ' * <br />MK3 <br />City State <br />srs3ii U9-31S- <br />Zip Phone <br />I understand my rights as stated above. <br />/Signature <br />Tdephoae (612) 249*4 <br />O fit i /; r\.