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1 171C OF RESTRICTION OF USE 5\A5 �$U50I) <br />and Notice of Right to Appeal <br />DATE: TIME: CASE #- <br />15. 3dwi <br />LOCATION (PA RK/O PEN SPACE): <br />A. SI IF 11 11111 11 1 Ii 1 11 1 1 1 1 IRI III iii 5 <br />W Entering in or using all City of Eugene parks, open spaces or facilitiA <br />a <br />The basis for this Notice of Restriction of Use is that on 1 "1157--, you violated Sect <br />W <br />I Park <br />and Open Space Rules, and/or Section q__g_ql of the Eugene Code, 197 1, and/or ORS -, To wit, you: <br />L-j > <br />Pursuant to Park and Open Space Rule R-1,074 you are entitled to an informal hearing to contest this Notice. A request 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 />72 hours (exclusive or wevicencls) ot receipy or I request Tor nearing. AL me unrorindi numing LIFL7717777 17777777 7M U771ty <br />consider testimony from you,, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident, 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 />This Notice of Exclusion was delivered to the person named at the top of this Notic the date and time shown above by: <br />(Signature of person issuing/delivering noticep <br />I hereby acknowtedge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />white Copy: Public: Work, Gr"ncopy: File Ye I I ow Copyi Report Copy pink Copy: Recipient Gold Copy Officer Appeal noiicc Re 04,'M <br />Name: [,:cwt first Middle <br />17013; <br />LA <br />G1 <br />Res. Address: city <br />State <br />Zip <br />Res. Phom�: <br />Work Phone: <br />z; <br />A. SI IF 11 11111 11 1 Ii 1 11 1 1 1 1 IRI III iii 5 <br />W Entering in or using all City of Eugene parks, open spaces or facilitiA <br />a <br />The basis for this Notice of Restriction of Use is that on 1 "1157--, you violated Sect <br />W <br />I Park <br />and Open Space Rules, and/or Section q__g_ql of the Eugene Code, 197 1, and/or ORS -, To wit, you: <br />L-j > <br />Pursuant to Park and Open Space Rule R-1,074 you are entitled to an informal hearing to contest this Notice. A request 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 />72 hours (exclusive or wevicencls) ot receipy or I request Tor nearing. AL me unrorindi numing LIFL7717777 17777777 7M U771ty <br />consider testimony from you,, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident, 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 />This Notice of Exclusion was delivered to the person named at the top of this Notic the date and time shown above by: <br />(Signature of person issuing/delivering noticep <br />I hereby acknowtedge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />white Copy: Public: Work, Gr"ncopy: File Ye I I ow Copyi Report Copy pink Copy: Recipient Gold Copy Officer Appeal noiicc Re 04,'M <br />