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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 /> � . <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 /> �c� � U�Cr�,i►. <br /> First Middle Last <br /> 13 ov ►�`,�� �1 <br /> Address <br /> � ro �a �� SS 36� �s�a-y�a-�g�� <br /> City State Zip Phone <br /> I und a# ve. <br /> Signature • <br /> � �-`�e:�,ti �'=�:•,.. <br /> �- ��.� �" L.,� ,�J`�=�?. .�„ �� � <br /> . - . �� `'+�� t�ii�� �'t�,''-' ; Y�'1 ''.� �9'•,:�..�• <br /> • ._: .;:`-'l z1' . <br /> _ � 'X ,.y.• ,,,^'=,�5` .:^:%z..��.,y�+� '��j <br /> � `�� �}fY>. t� �.; -� � I I � <br /> ,' ,� 4�;' �,.��;,�., �:;��::� �'�,�.....;�'� 1�. <br />