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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 certa in 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 perm it or license requires Council action to approve , some information <br />may become public. <br />5 . You have certa in 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 />(:)rV'AD VV] 5$3 SC/ ~ <br />City State Zip <br />~· <br />Signature <br />_.,.