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. � <br /> DATA PRIVACY ADVISORY <br /> �in acxordance with M.S. 13.04, Subd.2, "Rights of subjects of data",we woufd like to inform you tfiat your <br /> request for a permit or ticense from the City of Orono or arry of its departrnertts may require you t�fumish <br /> � certain private or confidentiai informafion. � <br /> You are nofified that <br /> 1. The information you fumish wiii be used to determine your qualificafion far the permi�or <br /> license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the permit or <br /> Crcense. <br /> 3. The information may be shared with other tocal, state or federal agencies to the extent <br /> necessary to process the peRnit ar lic�nse. <br /> 4. If yaur requested permit or license requires Council acfion to approve, some information <br /> may beoome pubfic. <br /> 5. You have certain rights under M.S. 13.04 (see follawing page) to raeview private data on <br /> yo�,��. . <br /> 6. Your full name is required to process this application or permit <br /> t »at� �c- � <br /> Frst Midd(e Last <br /> SS� �-�-z- L�,6 � �.� �,.-� <br /> � Aadress <br /> t�s�,-�%� '`�,� ��3`�E � 1 �3-Zy2-78 � ( <br /> City - Shate Zp Phorte <br /> I unde nd my rights as st�ed abov <br /> Signature <br /> This is an informafion sfreet Every effart has been made to insure ttre accuracy of the information contained l�erein;� <br /> frowever,if any infomlation is not consistent with provisions of the City Code, the Code provisions wi/l prevail. <br /> cuP a�a ou,e�Land use Appr�t;o�s �1'ECE I�0'E D <br /> Last Updated: November 30,2009 <br /> 1Q JUN 21 2010 <br /> � � � CITY OF ORONO <br />