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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 requireythat the City deny the permit or <br /> license, - <br /> 3. The information may be shared with other local, state or federal agencies to the extenf <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 dafa on <br /> yourself. <br /> 6. Your full name is required to rocess t►�is application or permit. <br /> t '�s � � e r- ��2<i�-z� J7/l�-fi-v �icr /�L..� Cr <br /> . --,L � <br /> �'irst � � d le Last � <br /> � . �`7 3�' �/Z ���¢�e �- <br /> �`� fs; Addr ss 2 <br /> ��� �v �����t�„�� /�r N S�"+�-ZZ_. ��-` .5.3�—� �� <br /> City State Zip Phone <br /> I underst d ights as stated above. • <br /> Si t r � <br /> a/ �-�� �:... ,,� n.�•:� I <br /> . � '�l C`.� ...._ �f��•'1 . <br /> �; ;:S ;: <br /> �s�c• ;:a �G' . .. . . ' ' . <br /> �,' �:;,�` . `" .•. , . . ' � . • . .... ,..47,:: <br /> �. _} ,'.� `•. -_.....��� <br /> . . � j.�� �;�.:.i�✓�''�� � ���'.:.;.3�' "w:5:.:�: •i�w^l <br />