Laserfiche WebLink
� , <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjecfis 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 depar�ments may <br /> require you to furnish certain private or confidential information. . <br /> You are notified that: <br /> 1. The information you furnish wil( be used to determine your qualification for the perrnit 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 application or permit. <br /> GS's���� (L�G V�� /-? �y� �o�- <br /> First / Middle��� Las� <br /> � �,�f�d G�,�//S'�/G C__11�+i V � ��� <br /> Ad�ss �i:y /f� � � ��i, J �✓��� �5�—����.���.�� <br /> i4 � � //Y <br /> City � State Zip Phone <br /> I un rstand my rights stated ove . <br /> � � <br /> Signature <br /> �Sf,�,V^�:'� �''� `� �`�'y'1' . . <br /> E� ��.;'z/ :�, 't,. t,� 'i: nsc:�y> �;;P.µ .ry <br /> ;�r,.. <br /> ar:���c. ;.;� e;� , .. t �,. ;`.�� yr�s} ,.yy.. <br /> ��. }r ."3 .. f�1 .:riT..?. <br /> �'���� ' ., � '' :^; . <br /> �, f-� � �� a : �:� <br /> ,.0- �'�4.w.i� � .�fi`� :;�� :..;i <br /> . . �:+wra��::�" i..:.e.�y.< <br />