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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: 1' , TIME: 1Z553 CASE #: <br />LOCATION (PARKA)PEN SPACE): <br />o� <br />L�(_ <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />notified that Nrou are prohibited from (check box): <br />�z Entering in or using all City of Eugene parks, open spaces or facilities. <br />X <br />The basis for this Notice of Restriction of Use is that on you violated Section Zpj q of the Park <br />Pursuant to Park and Open Space Rule R. -1.074 you are entitled to an in forinal hearing to contest this Notice. A request for an <br />infon 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 ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the in formal hearing to be conducted, which shall be not more than <br />72 hours �',excf usive of weekends of recei%,t o r the r wp iesa for h f-.q r'n.*- A I t li)- in <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />i neident. The D ivision Director may exclu de anyone, other than you and those presenting testi mony, fro rn the informal hearing. <br />This Notice shall remain in effect pending any requested bearing. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />(Signature ol'person issuing/delive ing notice) <br />I hereby acknowledge receipt o F the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />White C opy: Public Works Green Copy: File Ve[kgw Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer AppiW notice Rev- 04.'03 <br />Name: Last First Middle <br />DOB: <br />RaceSe <br />O,Z_C)g _ n <br />t M <br />E , 4 <br />Rcs, Address: Citv <br />Pp evL <br />ta te <br />� <br />Z <br />T <br />cs. Phone: <br />Work Phone: <br />r6aswj L6L 6�-_6 <br />�J <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />notified that Nrou are prohibited from (check box): <br />�z Entering in or using all City of Eugene parks, open spaces or facilities. <br />X <br />The basis for this Notice of Restriction of Use is that on you violated Section Zpj q of the Park <br />Pursuant to Park and Open Space Rule R. -1.074 you are entitled to an in forinal hearing to contest this Notice. A request for an <br />infon 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 ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the in formal hearing to be conducted, which shall be not more than <br />72 hours �',excf usive of weekends of recei%,t o r the r wp iesa for h f-.q r'n.*- A I t li)- in <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />i neident. The D ivision Director may exclu de anyone, other than you and those presenting testi mony, fro rn the informal hearing. <br />This Notice shall remain in effect pending any requested bearing. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />(Signature ol'person issuing/delive ing notice) <br />I hereby acknowledge receipt o F the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />White C opy: Public Works Green Copy: File Ve[kgw Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer AppiW notice Rev- 04.'03 <br />