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DATA PRIVACY ADVISORY <br />., ·~ <br />•· -.., '• <br />In accordance with M.S. 15.165, "Rights of subjects of data",··:. <br />we would like to inform you that your request ·for a permit or ' • ·-;· · <br />license from the City of Orono or any of its departments may ·· · <br />require you to furnish certain private or confidential inform-· <br />ation. <br />You are notified that: <br />1. The information you furnish will be used to determine <br />your qualification for the permit or license requested. <br />2. You may refuse to supply data, but refusal may require <br />that the City deny the permit or license. <br />3. The information may be shared with other local, state <br />or · federal agencies to the extent necessary to process <br />the permit or license. <br />4. If your requested permit or license reqires council <br />action to approve, some information may become public. <br />5. You have certian rights under M.S. 1s:165 to review <br />private data on yourself. <br />6. Your full name, and date of birth are required to process <br />this application or permit. <br />Thomas A, ,Judd <br />First Middle Last <br />1055 East Wayzata Blvd., Suite 219 <br />Address <br />Wayzata, MN 55391 <br />04-25-46 <br />Date of birth (does not apply to building/general permits) <br />473-4402 <br />Phone <br />I stated above~·· <br />.·. . . . --... <br />-··---··-......... -----.. ... •···-·•-•,.