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� <br /> Sec.13.0a RIGH't'S OF SZfBJECT`3 UE DATA <br /> Subd. I. Typ�ol da�a. Tha rigbcs uP iindividud oe whom�he da�a i�s[orad ar ro hs siored ahall be as se�forcd ia d►fa secdon. <br /> Subd.2- In(ormation required to De Qivan fndlvidtial. ,�n Indiv�dusl d+ked a supply priv4�e a�contidenoal din concerning himaelF shsll <br /> be inPotmed of: (a)the Durpose enJ ia�nded use of the re.qua��ed dat�witbin d�e colieCdng 6tata egeucy.poUtical svhelivision.or su[awide syscem: <br /> (b)wherher hs may rofl�se or is Iegrlly requiKd so supply thm rrquesro�!data;(c)am Irnown consayueace arising from hi�suppfyin�oc refusing ro supply <br /> privs[e or contfdenaal dwn;and(d)�he idanriry of odmr persons ur cndeoa nu�honzed by suce or federai law io rscei���he dacs- Ihis ceyuiremau sh;ill <br /> no�apply when an+ndividual is asked to supply invastigonvo dau,pursunn�co aecdon 13.82. eubdlY�sion S, co a law anPorotmcnc off�ccr. <br /> mn AtQner Qf[arenuc me� at�cc el�e nQn��e?'eH1dLd vnder�his subs�f�,}ion i �l+e individunJ i come rax��, r�RE���°3 <br /> �.s��it <br /> �gtty �i�o.o_s ins_send_of on�o�e lQrrtte. <br /> SuMi.3. Accesa to deta by iadlvldual. Upon requ¢sc ea a rcspansiDle QueAonry,an individuaJ shrll be informed waesAer Ar la sha wbJecc <br /> of senRd da�a on indlviduals,and whc�her ic�s clasaiflcd aa public, priva�e or coaCbondal. Upon ttis lunt�er reyussc,an iAdividurl who is ihe subjeee <br /> of asnrod pnvaw or public dat�an indirviduWs aRall be shown �he da�a wi�hou�a�+Y chnrge�o him ond, if he dcsina, ahall be informad of�ha concenc <br /> ancl me�.nir�p uf we�daca- Atear an in�irvidunl ha�ban shawn che pnva�e dn�a 3nd informcd of i�s mesnu�g.the 1am need no�be disclobod ro him for <br /> ois a►oath��etaaftac unleos n dispute or scaon pursuan�w �his 3ecdvn ix pendfng or e�fditianai dn�a on ihe indivfdual has Eeen collecud or creaced. <br /> Tha reapunsibla 4ulhosiry s�oll provide copies of ehe privur or publ{c dam upon requesc by the individual subjest of+ha dam. ll�c rosponsible auchuriry <br /> may requiro eAe rayuaedng peraun to pay che accua!cos�of malcing,certityin�. ana compifing�he co�leo. <br /> 71�a reaponsible wehorfry shell comply immcdiardy,if pa9�hle, with nny reyuexc rtsadc pursuant tn this subdtvision,o[wichln five days of <br /> tAa dn[e oi u�o reque�c,cxc{udtng Soucndoys,5urufays and leya{haGdays.if immediaro cumplianc;e i9 noc pusaib{a. It he canno[tomply with the aque:st <br /> wlthiti rhie tima,ho shalf ao infonn�ha vxi�vidual.�nd may have an oddidonel fiva days w+�hin Whicli to comply wi[h rhe rcquess,cxctuding SaNrduys, <br /> Sundaya and 1egu1 holilays. <br /> Subd.d, Proeedure whaa dala is not uccurots or comple�e. An iridividual may con[es[nc�atcuracy or complemnesx of public or pri�•��e <br /> dau cancemin8 hfmself. Tu�xrrcis¢�his right,an individual shall ncirify in wririnq the responsiblo au�horiry describin��he nawre of d�e disagreemrnc. <br /> Tba responsible aurhoriry shnll Wirhin 30 days eii►+ar: (a)correce�hc do�a feund�o Ge inuccurate or�ncompfe¢and aaempt ro nndly past recipiencx uf <br /> inaccurm�n ur inaompleu data, ineludinQ recipien�a namcA by the indiYidual: or(b)nodfy 1he irulividual�ai he believes die daea co ba comcc. Dsta <br /> in�l�spuce sh�ll bo dix:losr.d only IP rhe individual's s[akmenc o!disagrecment is includad wi►h[he disclosed dacs. <br /> Thn detorminanon uf rh�rexponsible au�huriry may ba appeoled pursuanc to the provisiany of the adminiatrarivc procedurc acc rtilacing �u <br /> coNCft[d caAty. <br /> D�p�r,��Y ADV�SOI�Y <br /> Ia accordance w+ch M.S. 13.04, Subd.2, "Rigbes of subjects of detu",wc would like co infurm you thec your requesc <br /> foc a permi� or t�eense from �he City of Orono or any of its departments may require you co furnish cercain Qrivate or <br /> conftdenctai informacion. <br /> You are natified that; <br /> 1, 7'he infarmation you furnish will be u3ed co determine your qualification fot the permi[orlicensc requested, <br /> �, You may refuse �o supply datn, but refiisa! may teguire that the Ciry dcny the permit or license• rocess <br /> 3, The information may be shared wi�h ocher iocal, state o�federal agancies so the excen�necessary co p <br /> che pennit or license_ <br /> q, If your requts�rd permi� o� licease requires Council accion to appmve, some infacmacion roay become <br /> public. <br /> S. You have certain cights uncter M.S_ 13.04 (avaiiablo uQon request) to review priva�e data oa y�urselF. <br /> g. Your full name f.s required to process this applicacion nr ncrmit. � <br /> � <br /> C? ^ ( '� ��,�,�,/�� <br /> First <br /> Middfa Laxe <br /> � xaa�dy , � f� � �� <br /> � � � �;,����,� � ,.:��;��� �- �J J <br /> �<<� Phona <br /> Ciry 5uua Z�P <br /> I uctdcrs[and my righcs as szAccd above. <br /> , � � __ <br /> _�____.��'- ����� - <br /> Signawro <br />