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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 quafification 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 pubfic. <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 /> C, c�'J'1 ' �-,.Gtn'1--� � c�r�.. vr., <br /> First Middle ast <br /> � js� `-�1�.y;� ���- <br /> Address <br /> � G V vY�-� �c��i� • �cC✓'�b'� �S� `�7�- �'I f � <br /> City State Zip Phone <br /> I understand y r-igi� s stated abo, e. �,.. <br /> ?'U=-- �' <br /> Signature � � � <br /> fi� <br /> �: , , <br /> � �-., �� � � <br /> , � � <br /> �i t%7 ,�.:�`:":r'L FL'f:.t ., }�i �. <br /> . � �� �� � � �� � �, ;� ��� � ���� <br /> i 1 ) <br /> i . •,y i yr• �•t . , t��� � I�'� ��`�i...w] ��k�f'f�--- <br /> :. I � i ��,f� e+` # � ��.� �t.,.. t r <br /> � i j� i 1 �.! j3,��2}r�' <br /> i i � i <br /> � tk ���� 1 , i . . � 1�i �� ,i�� i � I 1 ��� ., ,� �i :�'i .����, <br /> . � i � .. . 4 ':��� � .. . ,.�il, � .. 1+ ._. ... . . . .. f .,, _i.i�l, . . . �� . , , .., � .. i . .� ' _ . <br />