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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 application or permit. <br /> �r�.�� r��y ��, �� L► � x�► � <br /> First Middl Last <br /> �� ���5 �aX ��fl� L� <br /> Address <br /> H-�.r.�� �� � �► �� ���o ��� ��o �12� <br /> City State Zip Phone <br /> I understand my rights as stated above. <br /> ��`�-� <br /> Signature . <br /> �/i y/�7 ry_,..•+;`. .•:��.: rn� �j-,:� <br /> 9 �J Lr '':(h �' '����. f:�? �"��'�t <br /> �.��r_,��. f. .:� .,J / .t•' ;:� ,r.•�!'` . <br /> 4Y, f:f(>Y:7 G:. . .:� . <br /> •� t � ' ...i•-.�:� �.... .:_..;�!.:..•:•: �,....ci:i�;;;?:'� <br /> «V c�' �:', ,,;r ;;`i ., <br /> } ��-�:..,r,.:_; ess_�.�:.a r;�_�ut <br /> — i <br />