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NOTICEOF � USE S rls � o -x i <br />U RESTRICTION OF <br />and Notice of Right to Appeal { <br />DATH: _ 3 t]` TIME: 17 j `� CASE #: 15-1lo� <br />LOCATION (PARK/OPEN SPACE): MJRVIAS �{'�}3J (y �-- <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 />A/ 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 f Ir f you violated Section ell 41 the Parkand Open Space Rules, and/or Section L . '7 of the Eugene Code, 1971, and/or ORS �����. To wit, you: <br />NOR <br />(Description of the violation.) <br />This restriction of use is effective beginning on -nt IJ , and shall remain in effect until + �� <br />If you enter in or use any City of Eugene 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 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 44 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the informal 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 />incident. The Division Director may exclude anyone, other than you and th ose presenti ng 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 Noticc at th - at nd time shown above by: <br />(Signature ref persiin 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 Ureen Copy: File Yellow Copy. Report Copy Pink Copy: Recipient Gold Copy: r ?Qii r Appeal notice Rev. ()4!03 <br />Name: Last First htiJ.tiic <br />DOW <br />R aec,'Se.x: <br />44J7 I- <br />3 <br />4 <br />t2 <br />Res. Address: City <br />State <br />Zip <br />-z <br />Res. Phone: <br />Work Photic: <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 you are prohibited from (check box): <br />A/ 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 f Ir f you violated Section ell 41 the Parkand Open Space Rules, and/or Section L . '7 of the Eugene Code, 1971, and/or ORS �����. To wit, you: <br />NOR <br />(Description of the violation.) <br />This restriction of use is effective beginning on -nt IJ , and shall remain in effect until + �� <br />If you enter in or use any City of Eugene 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 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 44 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the informal 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 />incident. The Division Director may exclude anyone, other than you and th ose presenti ng 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 Noticc at th - at nd time shown above by: <br />(Signature ref persiin 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 Ureen Copy: File Yellow Copy. Report Copy Pink Copy: Recipient Gold Copy: r ?Qii r Appeal notice Rev. ()4!03 <br />