Laserfiche WebLink
► <br /> / � <br /> � � .. ..�� �j� �i� �� <br /> �-� � '�~r !� r� �,,�.rw:.•c� <br /> �y �f, ��`�'� <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2 , "Rights of subjects of <br /> data", we would like to inform you that your request for a permit or <br /> license from the City of Orono or any of its departments may require <br /> you to furnish certain private or confidential information. <br /> -You are notified that: <br /> :<�. . <br /> 1. The information you furnish will be used to determine your <br /> qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or license. <br /> 3. The inf ormation may be shared with other local , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Counci 1 action <br /> to approve, some information may beccme public. <br /> 5. You have certain rights under bi.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> �- , ,�a 6'�'� �T�P i� ►� rT__ <br /> First Middle Last � <br /> ��`"� LPO� -� S?"+ <br /> Address <br /> �,�r�r�n /'Y1 n . ��.� � (� <br /> City State Z1p <br /> y�-�w q� <br /> Phone <br /> I understand my rights as stated above. <br /> igna ure <br />