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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 <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 requi.re 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 /> bp p r�/It?'2Tti/ S��{-A-rBL� <br /> First Middle Last <br /> J�S�D C��k��/ /�Ll�� <br /> Ad O�aNv �'YI�t/ �S'3lo � 9 S z ��� ��L <br /> City State Zip Phone <br /> I understand m rights as sta -��above. <br /> / � ; <br /> Signature <br /> , �,;s,-.. �� <br /> �--�, �, <br /> ;j� ,� �h, �. �':,� <br /> [� o c� r�a ?i ? <br /> ���t :�'� N�3 eP�:,i 4 .•� f:� �.a i <br /> r � <br /> h. r � :� �,j u�,�T.+�'"' <br /> 4 Jv <br /> �i��C7 ���� r pl i � r�� �: � <br /> (v;'1 f �` e � �s 1� <br /> 'G.,�u.�,ys �� ...,.. N � ..'ti;.:l �'�� .ru��^� �'. <br />