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� DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we wouid 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 requi.re 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 /> �b�� ✓��.T� �G���a L� <br /> First Middle Last <br /> J��D C�Ek 2 �� /�L�1'G� . <br /> . Address <br /> o���v� t�I•r� .5��3� � q s z y��/ ���- <br /> City State Zip Phone <br /> I understand m rights as sta above. <br /> � ✓ <br /> Signature <br /> T� �' �'3Y��; .' ��';�, ���� ' �'� � <br /> ef�,�,.�.'�"" �';� �?::� tr;;.? ��l;�d t <br /> � ..t1 � � r,5� ' , " ��{i' �fi . <br /> . i��3��7 . `�t�. `,�,. �•�Vt 4�� <br /> k� .. ,..y,. <br /> �t� .,;� ;•:` �jr ;,`2 �;� �� , t. <br /> . ��:.�^�'i.i-%'y "���ti:_iY.1'+� �f��:.•' �' � <br /> u: .cd �,e, .�' <br />