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� � <br /> � .. <br /> � <br /> . <br /> D�►TA 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 confidentia( information. <br /> You are notified that: <br /> 1. The information you fur.nish 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. 93.04 (see following page) to review <br /> private data on yourself. <br /> 6. Your fufl name is required to process this application or permit. <br /> � c <br /> �11.�1/�N1 �' Rf�f� �I £ M ,2�sP����v�LY � ���1 <br /> First � Middle Last <br /> �3s�s� � i �n�.w� ��J <br /> Address <br /> ��o�va �� s3 3s�j q sa �f�� ��3� <br /> City State Zip Phone <br /> I un rstand • rights as stated above. <br /> � <br /> � <br /> 7 <br /> �1 �3 �r,.:?.; ":5 r' °'^ t: r.: � ;a <br /> �� k'' ' r, "{ r' '*r <br /> ..��J?"r'�.yu �iiC' st S,; � l. `� �`� <br /> .. �;t�,Sa'�.'^ `�''�1 ', � .Y <br /> +� tn� �,'_'��. ,��',i 1�L�9 � �! F/..fI <br /> $� `!',,:.r.��.��i� G..�':: ::7 ���i'� U:! <br /> 1 <br />