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pATA PRIVACY ADVISORY <br /> In accorciance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2,"Tennessen waming", we <br /> would like to infortn you that your request for a permit o�license from the City of Orono or any of its departmerrts <br /> may require you to fumish certain private or conflderrtial ir�formatlon. <br /> You are notified that: <br /> 1. The iMormation you fumish will be used to determine your qualification for the permtt 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 informadon may be shared with other local,state or federal agendes to the exteM necessary <br /> to process tl�e permit or license. <br /> 4. If your requested permit or license requires Coundl action to approve, some information may <br /> become public. <br /> 5. You have certain rights under Minnesota State Statute 13.04 (see following pa�) to review <br /> private data on yourself. <br /> 6. Your full name is required to process this application or pennit. <br /> Joan Michelie O'Donneli &Timothy Michael O'Donnell <br /> First Middle Last <br /> 559 Park Lane <br /> Address <br /> Long Lake MN 55356 309.361.9302 <br /> City State Zip Phone <br /> erstand y�i ts as tat above. <br /> � <br /> Signatu <br /> PadcetLast UpdeAred: Jaiwary20f5 <br /> P�e7 <br />