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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: 9 ; 1 Wm CASE <br />WCATION ( SPA(.'E,) <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005( you are herehy <br />notified that you are prohibited from (,check box). <br />P C Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on 0SI M Y OU violated Section LON- -01 of the Park <br />and Open Space Rules, and'or Section of the Eugene Code, 1971, and/or ORS --- To wit, you: <br />SLEERIL(4b� TP-j a <br />rhis restriction of use is effec�tive begirtning on�L�� " and shall rMainj" elleound <br />The, Di i, i gion Director shall schedule a time and place for the infori hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice and other witnesses to the <br />incidcnt. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />Thi % Notice of Ex was de I ivered to the person named at the top o I'th is Notice Zt d ate and time shown above by: <br />, <br />(SignatUre, 0i'den',on issuing/defivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated ab <br />on being ISSLIed the 110tice) <br />While Copy: Public Works G Copy: File Yellow Copy, Rcpork Copy Pink Copy, Recipient Gold Copy: Of Appes I notice Rc%, 04!01 <br />Namq�: Last First Middle <br />D061 <br />Ram'Scx <br />J , V <br />Res. Address: City <br />ate <br />St <br />Zip <br />Res, Phoney <br />Work P(,one: <br />i <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005( you are herehy <br />notified that you are prohibited from (,check box). <br />P C Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on 0SI M Y OU violated Section LON- -01 of the Park <br />and Open Space Rules, and'or Section of the Eugene Code, 1971, and/or ORS --- To wit, you: <br />SLEERIL(4b� TP-j a <br />rhis restriction of use is effec�tive begirtning on�L�� " and shall rMainj" elleound <br />The, Di i, i gion Director shall schedule a time and place for the infori hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice and other witnesses to the <br />incidcnt. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />Thi % Notice of Ex was de I ivered to the person named at the top o I'th is Notice Zt d ate and time shown above by: <br />, <br />(SignatUre, 0i'den',on issuing/defivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated ab <br />on being ISSLIed the 110tice) <br />While Copy: Public Works G Copy: File Yellow Copy, Rcpork Copy Pink Copy, Recipient Gold Copy: Of Appes I notice Rc%, 04!01 <br />