Laserfiche WebLink
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 require 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 /> ����� ��-I ���fa�, <br /> First Middl Last <br /> �3�l ���,.N i2�d�,.� �d. <br /> ��Addr s <br /> n U v�� 1�/I itJ S.��l��6�z� 2D9 S91� <br /> City State Zip Phone <br /> I unde tand m right s stated above. <br /> � � � <br /> Signature , <br /> x-�:.� � <br /> ��w1�:�cd� <br /> „x-,=s:;�,.;,, , <br /> ,;s:,, �<�' �,.� �r; / <br /> ��'.� �:-�,.a, �r, ,y��1. ;�;, a;, . <br /> � J,�.,' �.:a' ' '.I �'i a��( <br /> ��'�'�' � t> ,�, �., ��� <br /> ���.��:. / -i.y ;:i': �.:..�:�" <br /> p ; r,��J'�;i` 'r C:�:e+=C_'%.G' c <br /> �.... .. <br />