Laserfiche WebLink
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 /> yaurself. . <br /> 6. Your full name is required to process this application or permit. <br /> . . M���,�.�1 �an �� � � ��,�-- . <br /> Fi t Middle Last <br /> 2n ��'f' �fi-�. /OC7 <br /> Address <br /> � �x� olS��r� � �1/✓ 5533� 9S�• � 70 �5 7S� <br /> City State Zip Phone <br /> I understand my rights as sta d a <br /> S' nat re � <br /> ��Y �:,, k�� , x: <br /> �r;;���,—rt � �' �� a:''�7, k �� <br /> af '' ..y ��., � v� �° ;i� <br /> ����',��Z1 ��r:n �i:�..'!�*"`""'+ r h��"� � � :jj�� <br /> � �51 �'�. �� 4�•... �.��1 �;;'�u�ti,ta'UiN w , �'j� <br /> ... S ;.{::' , 1 <br />