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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 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 appfication or permit, <br /> ���.�.� �� - ����a✓� <br /> First Middle Last � <br /> ,5�,s' ,��X�.��, G �� ,�y . <br /> Address <br /> �'�� �/��- i,'�'i'a�- 5��9� �s"� �S'���i�-...�� <br /> City � State Zip Phone <br /> I understand my rights as stated above. <br /> ��� ._. <br /> Signature <br /> , <br /> ? �'-.,,;�?; ��-; a` `,•,' � •'• <br /> \ ��t�� JYt� '� �r-. <br /> 'y;� '? .;a }t r 4 � <br /> .��. �a'� a� a.1y+ � ! �•: i`4}+ t:• r)� ri� , . <br /> 'U•' J��y:t� j tU,l/-T"',.'m"� � <br /> ��4�• •i��ii :.:T'�� F�./ <br /> � �.���� •:5*+�� 4.:,� .�y' � 4j+ M1�i: <br /> 4N L'� �479x�"�n} ��,•�<lr"'I"l'✓� f�,'���\.�✓ � . � <br />