Laserfiche WebLink
,. <br /> DATA PRIVACY ADVISORY <br /> In accordance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2, 'Tennessen <br /> warning",we would like to inform you that your request for a permit or license from the City of Orono or any <br /> of its 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 your qualification for the permit or <br /> license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the permit or <br /> license. <br /> 3. The information may be shared with other local, state or federal agencies to the extent <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 Minnesota State Statute 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 /> ?SAV t .4 Om ittc Vdi., -XP-Dvv---- <br /> First Middle Last <br /> /0 1 1 3 f5ee6C 41-kte-- Alr-1• <br /> Address <br /> 40evtviri___ <br /> City State Zip Phone <br /> I understand m ' tated above. <br /> Signature <br /> RECEIVED <br /> MAY 1 8 2017 <br /> Subdivision Application--January 2017 # 3945 <br /> CITY OF ORONO <br /> Page 13 <br />