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DATA PRIVACY ADVISORY <br />In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that <br />your request for a permit or license from the City of Orono or any of its departments may require you to <br />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 license <br />requested. <br />2. You may refuse to supply data, but refusal may require that the City deny the permit or license. <br />3. The information may be shared with other local, state or federal agencies to the extent necessary <br />to process the permit or license. <br />4. If your requested permit or license requires Council action to approve, some information may <br />become public. <br />5. You have certain rights under M.S. 13.04 (see following page) to review private data on yourself. <br />6. Your full name is required to process this application or permit. <br />/µI /1 f_f O f)e/' t'/~ 2 L ' L ' C ~ /T'\ <C2.. 1 I _ MIDo{_E <br />~ '--' / ~"K CD;, / <br />ADDRESS !: ~4 //_,J w J J.-f,_3.. //I, <br />CITY STATE, ZIP <br />14 <br />LAST <br />PHONE <br />r: <br />If <br />RECEIVED <br />DEC 11 2009 <br />CITY OF ORONO <br />343