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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 <br /> to inform you that your request for a permit or license from the City of Orono or any of its <br /> departments may 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 <br /> the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny <br /> the permit or license. <br /> 3. The information may be shared with other local, state or federal agencies to <br /> the extent necessary to process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, <br /> some information may become public. <br /> 5. You have certain rights under M.S. 13.04 (see following page) to review <br /> private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> w�� �,� �� <br /> First Middle Last <br /> ��Z� ��J�6'�'�%� ��� <br /> Address <br /> l�G��C��i'�- �%�� �° �`� � �.�z�z <br /> City State Zip Phone <br /> I underst n tated above. <br /> Signat e <br /> 7 <br /> , � �. <br /> � � � t r,� <br /> 6 2 l 3 1.f <br /> tr I.. f , . _ ` 1 �1 �o-'3"°9 <br /> r � ,,,,, „7J �.J � I::; Y ", ;� ��� <br /> �;C�,� ca.� Fi: �'�i ;�` g� <br /> � � <br /> �,a...d �_ ' ��� <br /> � ��� �� <br /> ��� � <br />