Laserfiche WebLink
. � , <br /> DATA PRIVACY ADVISORY <br /> ln 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 confidential informafion. <br /> You are notified that: <br /> . 1. The information you furnish 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. 13.04 (see following page) to review <br /> , private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> ��1� �o /���'�✓Z . <br /> irst Middle Last <br /> r�I/ ��/(��� �i�,/�''I C'l/� L�c� . <br /> Address <br /> 1����9a ! • ` / - r ✓ �1 9/ `—�/� l���� ��/ �� <br /> City State Zip Phone <br /> I understand my rights a state ove. <br /> . � � <br /> Signature � � � <br /> 7 <br /> �r I .�s�i;. .,w� <br /> j ,� �'•'i2, f i;.� �?` y,� <br /> • !Y �, /� tf: p.- ! <br /> �'%3�jt�.�'e, 4�� {,,, �� `3`:.1 -� �Y , �� � <br /> .�^�J7'.� :� N,;,• ,�.� �; �' � <br /> �{ cG:�r,. f.�.� �i:'.::�,'� <br /> � 4`� r}Cf•`�"' -7 1y,i4\ L7;:1 �S) !i�1 <br /> � '� ��•�J�x f���.'� �9 y,F! V7" �..'�' 4. <br /> �+4'rt.....z;�F.Ca+ fJ `�a'n''i:L�yJ' +-itsur:i. � . i <br />