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Jan-06-1004 11:33am from-CITY OP ORONO +6522494616 T-6A4 P_006/008 F-608 <br /> See.13.04 RI6l�TS OF SIIBJEC'IS OF DA'�'A <br /> . Subd. 1. Type n[data. The righrs of iadividual on whom rtu dan is nored or[o he swrcd aha[t 6e as sec foesh ia d�is scctioo. <br /> • Subd.2. Ia[ornutia�required w be grsa io�ridual. M individwt uked oo wDD1Y P�vau or coofidemial dan coxecnin�4imself <br /> shal!be intomxd oh (a)d�Wcpuse�nd intcnd�nse ot�e requesud dan wtddn the collecdng snce a�ency.potitical subdivision.or snrswi� <br /> Sysam:(b)whedxr he may rntuse or is tcgslly rcquired w�upply die iequesad dam;(e)my kmwff eonsequeoet a�sig fivm 4is supplyi�or <br /> refusins w supply privaae or ta�Cideeri�i dan;and tm�he idendyr ot o�er persons or encnes�udroei:ed by sna or hderal law Io eeceive rhe dao. <br /> This requiremenc ahall na apply when in iAdividual is a:ked to supply imesdgauve dan.pu�susat to secRon 13.8:,subdivisioa 5,a a hw <br /> eaforeer�n�offieee. <br />' '1'he comm�ss�n���em�e enav ehee ehe rwtice eewireA onder thi:s�th4ivi.sinn in du individual iCcnrRe ex nr nronr,Yv tix,�ef�gi <br /> ;,ncmrctia iimead of nn ihnxe fnrtn.a. <br /> Subd.]. Accas tu data by iadi�iduaL Upoa request m a tespontible aurhoriry,an individuol sba11 be infocnud wpether 6e is the <br /> s�Djeec ol swced da�on individwls,and wheWer it te clusified u publie,privue or conlde�i.il. Upoe sis Nnher reyves4 an iadiv'idu�1 who <br /> is d�e�ubject of stored privaa or publ'�c dam an i�dividwls shW be�lfown d►e dam wid�ouc any charge c�Lim u�d,if he desires,shall be ialomied <br /> o!du coMau md rt�caning o[du�daet. Af�er an individw!Ipu besn shown�hs privau data and iofocmed of ia meaaiaQ,ths d�aaad noc Da <br /> discbsed ao hiro Por aiz maod�a du�Re r imless a diap�me or xqon pws�w�t w this see6oa is pe�dic�or�dditionsl dan on�ke individa9 has besn <br /> colleered'er eeraoed. 'It�respa�s�lc wd�oeity�iU provide eopies o!Wc privae or publie dm upon requeY by d�indi�al subjeet of tlu daa. <br /> �responsible audwr�y may«quire tlsc r�questiqq pe[son m pay rhe�ctvat co�s of matcing.eer6fying.and eompilicg�6e copKy. <br /> The re�pvttsibk su�kwrity sfiaU cvmply i�t�edia�ely,if possible,wirh aay requesc made pursuanc tu�is subdiv�ioo,or wid►ia Rve days <br /> ol rhe due of the request.eretuding Samidays.Swidays�nd legai hnlid.iys.if infinediace eomptiaace is�c pauiDle. It 6e cannat eomply wid► <br /> U�e request widon thac rime,he sl+all so iatorm�he individual,and may have an addidorol five Oays wirhia which w wmpty wirII�he requac, <br /> �xcludiag SaNrdays,5ur�s and legu holidays. <br /> Su6d.4. Pratduee wLw data�eot aaurate or eomplete. Aa iadividwl a�ay coures�du ucuracy or eomp(c�cnru of public oc <br /> privace dara cooce�lut�uolF, To exc�e thj.i cigtn,ao individual shall noufy in wriong d+e reiponsiWe wdari�descnbiag d►e meum of die <br /> dwgreeme�u. The�espons�bk aud�oriry tlull within 30 days cidwr. (a)cartec[d►a drp►found to ba iiaccusste ar mcanplec suW stu�opt w aooty <br /> past recipkncs ol irc►ccurue or iawmpka d�n.ineluding eecipiencs named by�e indiv�dual;or(b)nodfy the individual�sc 6e believes du Aan <br /> W bt eeeemet. Dan in dispute sbaR be discbud oely if Ihe iediv;dual's aneement of d;aagreemeo�Is iaclnded with tlte discloud dan. <br /> 'Ihe deteeminuion ot the nesponsibte auqioriry may be appnled pursuut co tAe provisioas of the admiaisaeove proced�re ut relating <br /> m eoettesced c�scs. <br /> DATA PRiVACY ADVTSnRY <br /> ln accordance with M.S. 13.04. Subd.2, "ltigbts of subjects of deta",we woald Ilke to inform you that your <br /> request for a pecmit 4r licen�e from the Ciry ot Orono or any of its depar[meats may require you to fvraish tertaia <br /> privAte or confidential informatien. <br /> You are noafud that: � <br /> 1. 7be information you fiunish will be used w determine your qualification for the permit or licease <br /> requested. <br /> 2. You may refuse co supply da�a,but refusa!m�y require thAt dte Ciry deny th�permic or lic�nse. <br /> 3. ?he informa�ioa aray be sbartd with other local. state or fedeca! ageacies to cbe extent necessary to <br /> process the peruvt or license. <br /> 4. If your requesud permit or licease requires Council action[o approve, some information may become <br /> public. <br /> 5. You have certain rights under M.S. 13.04(available upon request)to review private data oa yourself. <br /> 6. Your full name is required co proceu this applicatioa oc permit. <br /> ,)11r1� �� �iL.�� <br /> Firs� Mi4'dk Gst <br /> 2� �iDt.�.[��.y�E-�. �}'�. <br /> Addrcu <br /> �Nt� 1�A� �52• _��`�' <br /> C ry 5ute Zip Phone <br /> I und�rstaad tpy rights as stated above. <br /> �a <br /> (�/���►`i/2. <br />