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NOTICE OF RESTRICTION OF USE vomo <br />and Notice of Right to Appeal <br />DATE: OGoq I q T1,ME- 0 1 ; `6 CASE #: <br />LOCATION (PARK/OPEN SPACE): Az K Le'LOC11:75 <br />- - -- - - -- ------- --- - - - -------------- - - - ------------ ---- <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005( you are hereby <br />notified that you are prohibited from (check box): <br />Entering in or using all Ciq of Eugene parks, open spaces or facilities. <br />1 <br />The basis for this Notice of Restriction of Use is that on f)(0M I 1 A you violated Section e <br />%.1 lt of th Park <br />_aojv� <br />and Open Space Rules, and/or Section 4 , Z4 <br />W __ of the Eu gene Cade 197 1, and/or ORS - 1 To wit, you: <br />Pursuant to Park and Open Space Rule R-1.074 you are entitled to an informal hearing to contest this Notice. Arequest for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shallsehedule a time and place for the informal hearing to be conducted, which shall be not snore than <br />72 hours (exclusive of weekends) o receip o C the req LICSt fear hearing. At the informal hearing the Division D irector wil I only <br />consider testimony frorn you, City personnel involved In the incident that resulted in this Notice, and other witnesses to the <br />incident The Division Director may exclude anyODe, other than you and those presenting testimony, from the informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice orExclusion was delivered to the person named at the top of this Notice � Wthateand time, shown above by: <br />------------- <br />(Signatur 'pers n issurng/defiverjng! notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />(Signature of person being issued the notice) <br />Whke Copy: Public Works Green Copy File Yellow Copy! Report Cupv Prnk Copy: Rmipwnt Gol Copy ; 0 ffirver Appea noti e c R _ 04!0-3 <br />Nanw: Last First Middle <br />L)08� <br />Racy isex <br />LARZ.Aj <br />1, <br />/-kA <br />Res- Address_ City <br />Start <br />Zip <br />Res- Phone: <br />Work Phone: <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005( you are hereby <br />notified that you are prohibited from (check box): <br />Entering in or using all Ciq of Eugene parks, open spaces or facilities. <br />1 <br />The basis for this Notice of Restriction of Use is that on f)(0M I 1 A you violated Section e <br />%.1 lt of th Park <br />_aojv� <br />and Open Space Rules, and/or Section 4 , Z4 <br />W __ of the Eu gene Cade 197 1, and/or ORS - 1 To wit, you: <br />Pursuant to Park and Open Space Rule R-1.074 you are entitled to an informal hearing to contest this Notice. Arequest for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shallsehedule a time and place for the informal hearing to be conducted, which shall be not snore than <br />72 hours (exclusive of weekends) o receip o C the req LICSt fear hearing. At the informal hearing the Division D irector wil I only <br />consider testimony frorn you, City personnel involved In the incident that resulted in this Notice, and other witnesses to the <br />incident The Division Director may exclude anyODe, other than you and those presenting testimony, from the informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice orExclusion was delivered to the person named at the top of this Notice � Wthateand time, shown above by: <br />------------- <br />(Signatur 'pers n issurng/defiverjng! notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />(Signature of person being issued the notice) <br />Whke Copy: Public Works Green Copy File Yellow Copy! Report Cupv Prnk Copy: Rmipwnt Gol Copy ; 0 ffirver Appea noti e c R _ 04!0-3 <br />