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� � <br /> ', <br /> DATA PRIVACY ADVISORY <br /> � In accordance with M.�. 13.04, Subd.2, "�Rights of subjects of data", we would like <br /> to inform you that your request for a permit or license from•the City of-Orono or any of its <br /> departments may 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 yot�r qualification for <br /> � the permit or license requested. <br /> � 2. You may refuse to..suppl.y data, but refusal may require that the City deny <br /> the permit or license: � <br /> ' 3. The information may be shared with other local, state or federal agencies to <br /> the extent necessary to process the permit or license. <br /> 4. � If your requested permit or license requires Council action to approve, some <br /> . information may become public. <br /> 5. You have certain rights under M.S. 13.04 (see following page) to review <br /> private data on yourself. , � <br /> 6. Your full name is required to process this application or permit. <br /> .��-�L£� ��,�� C.��osE . <br /> �1;�.�i E �a-('CS �L �.os F <br /> First Middle Last � � <br /> [2 I �1 l.�l l��Hu 2s� T2-A-i L. <br /> , Address <br /> � O(2 t51'V c� . (�l/1� �5�3(� SZ 3�3-y I Z� <br /> City . State Zip hone � <br /> I u erst d my rights as stated above. <br /> ignature <br /> 10 <br />