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'\ <br />DAT A PRIVACY ADVISORY <br />In accordance 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 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 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 information may be shared with other local, state or federal agencies to the extent <br />necessary to process the permit 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 full name is required to process this application or permit. <br />W-AiZ!t7;+ <br />City <br />e . <br />Last <br />/11"1 5Ssl/ <br />State Zip <br />952 41'5fS3 <br />Phone