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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />� <br />DATE: w TIME: i <br />JO <br />CASE 4: 02L <br />LOCATION (PARK OPEN SPACE): <br />I III I I I I I I: I'M I I I I I I Ill! I I I I I' I I I 1 111 1 R 11,111,11 1 <br />e Entering in or using all Ciq of Eugene parks, open spaces or facilities. <br />011 <br />The basis for this Notice of Restriction of Use is that on a h b 9 you violated Section J. )f the Park <br />o ft <br />he and Open Space Rules, and/or Section . he Eugene Code, 1971, and/or ORS To wit, you:_ <br />(Description of the violation.) <br />This restriction of use is effective beginning on —�O �,)� q and shall remain in effect until 3 1 1 J <br />If you enter in or use any City of Eugene park open space or facility during the effective period of this Notice, you .nay be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule R - you are entitled to an informal hearing to contest this Notice. A TCqUCSt fix in <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Directors "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 />k i <br />(Signature of person issuing/delivering 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 />White Copy: Public Works Greien Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeall nowx Rev. 04,'03 <br />Name: Last First Middle <br />DOB: <br />1141 tf <br />71" <br />4 TOKK <br />ill <br />Res,. Address: city <br />State <br />Zip <br />Rcs. Phone <br />Work Phone <br />I III I I I I I I: I'M I I I I I I Ill! I I I I I' I I I 1 111 1 R 11,111,11 1 <br />e Entering in or using all Ciq of Eugene parks, open spaces or facilities. <br />011 <br />The basis for this Notice of Restriction of Use is that on a h b 9 you violated Section J. )f the Park <br />o ft <br />he and Open Space Rules, and/or Section . he Eugene Code, 1971, and/or ORS To wit, you:_ <br />(Description of the violation.) <br />This restriction of use is effective beginning on —�O �,)� q and shall remain in effect until 3 1 1 J <br />If you enter in or use any City of Eugene park open space or facility during the effective period of this Notice, you .nay be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule R - you are entitled to an informal hearing to contest this Notice. A TCqUCSt fix in <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Directors "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 />k i <br />(Signature of person issuing/delivering 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 />White Copy: Public Works Greien Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeall nowx Rev. 04,'03 <br />