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, �� <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we wouid like to inform you that <br /> your request for a permit or license from the Cify of Orono or any of its departments may require you to <br /> furnish certain private or confidential information. <br /> You are notified that: <br /> 1 The information you furnish wiil be used to determine your qualification for the permit or license <br /> requested. <br /> 2 You may refuse to supply data, but refusal may require that the City deny the permit or 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 may <br /> become public. <br /> 5 You have certain rights under M.S. 13.04 (see following page)to review private data on yourself. <br /> 6 Your full name is required to process this application or permit. <br /> Mark Schoening <br /> FIRST MIDDLE LAST <br /> Ryan Companies US, Inc., 50 Soufh Tenth Street, Suite 300 <br /> ADDRESS <br /> Minneapolis, MN 55403-2012 612-492-4442 <br /> CITY STATE, ZIP PHONE <br /> I understand my rights as stated above. <br /> d,��'�'�-r" � <br /> Signat e <br /> � !{ � �'ra, � �''. {�� ,i �• 5� <br /> ia� �f�• �2; f<:� � �c' <br /> �v�y�;z��:.�al '•� 1.:� :,u�t� t„i 4� ���:r:�.�i,'s�� 1 <br /> H.,.�r.V�.fwZ �`��'ils`. `:';%'' ji±�� :yf: 4. <br /> �.'�l :. ,� y L t; 2 F, rf <br /> �, /':� �''� .�t''."`:.y.•.� `'l�y,y��:11 �.k,�i'rr•nt.> <br /> f" 4;� ,-...�-�Fw,.� �''+l:a'• � <br />