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• . , f. . ., . <br /> � �. <br /> � �DATA PRIVACY ADVISORY <br /> In accordance with M.S: 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that <br /> your request for a permit or license from the City of Orono or any of its departments may require you to <br /> 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 license <br /> requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. <br /> 3. The information may be shared with other local, state or federal agencies to the extent necessary <br /> to process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some information may <br /> become public. . <br /> 5. You have certain rights under M.S. 13.04 (see following page) to review private data on yourself. <br /> 6. �Your full name is required to process this application or permit. <br /> ��f� �iF,J sd,J ���.J.J�'.��.�/� ��;�-�%r�rf-�csi.1'fo .�/`s��,�-r ) <br /> FIRST MIDDLE LAST <br /> `g'a a aZ /J�i,�.c1�'�Y�,rl/.�- !�//�',a, � . <br /> �AD RESS <br /> F�:�•s�i/F� �i� �S'�;'/ ��sa - ��i- c�sq� <br /> CITY STATE, ZIP PHONE <br /> I understand m ights stated abov . . <br /> , <br /> Sign re <br /> r <br /> - 14 - <br />