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NOTICE OF RESTRICTION OF USE <br />and Notice of [tight to Appeal <br />ec: <br />'I s <br />DATE: TIME: CASE <br />-- - -- -------------- ----------------------------------------- _2,(z _..W, <br />1,0CA"TION (PAR-KJOPEN SPACE): 164A 1 -, <br />s______ _-Cs <br />Name� Last irst Middle DOA(IX: <br />C <br />Ra AddTvss: CitY State Zip R e s. P111011110.: <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 you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />............................................................................ . .......... . . <br />The basis for this Notice of Restriction of Use is that on you Violated SCCti10T11 j ofthe Park, <br />and Open Space Rules, and/or Section . .......... . .... ___ ofthe Eugene Code, 1971, and/or ORS " To wit, ..... . ........ _ <br />... . ........ . . . . ............ <br />.. . .... . . .................................................. . . . . . . . . . . ............................. . . <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until <br />............. <br />--- <br />If" you enter in or, use any City ofEugene park., open space or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open. space. ule R. -I.074 you are entitled to an infiarnial hearing to contest this Notice, A request k.)i.- am <br />informal hearing; must be made in writing and filed with the Parks & Open Space Division Director (-(he Division. Dire: 'tor") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the fofflowing ad.drirss: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the infomial bearing to be conducted, which shall be not rnore than <br />72 hours (exclusive ofweekends) of receipt ofthe request fi.)r hearing. At the inforinal hearing the Division Director will only <br />consider testiniony firom you, C"ity personnel involved in the incident that resulted in this Notice, and Other WiIIICSSICS' to HIC <br />incident. The Div ision. Director may exclude anyone, other than yo u and those presenting test imony, from the i nfbiTn a l hearing <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered tcs the person nanied at the top of this Notice at the date and tirne above Iby� <br />........................................ . . . ...... . �7 ... . . .... . <br />(Signature ofpiurscut <br />I hereby acknowledge receipt of the above Notice on the date and birle indicated above, <br />d <br />(Signature of person eing issuied the notice) <br />Mike Cq)y: Public Works Giecm Copy: He Yellorm CopyRpurCopy Pink Lopy , Recipieni ('kAd (.'c7py, Dfficer Appcml maiwx Rrre v . 04AG � <br />