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NOTICE OF RESTRICTION OF USE <br />-land notice of Right to Appeal <br />DATE: TIME: �s /� CASE #: x' `Lj-7q 7d <br />LOCATION (PARK/OPF.N SPACE): <br />7 <br />Name: Last First n Middle <br />DO" <br />$_ ;; <br />Race.�'Fx: <br />L <br />_ <br />I�JJ <br />-222 (L- ��� <br />r'f <br />{SP � <br />Res. Ad`lt(( City <br />t rj•ti�r <br />State <br />Zip <br />RecJ�+Se: <br />Work Phone: <br />-�� <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 />Fl <br />The basis for this Notice of Restriction of Use is that on rd wx- Y-/ r , you violated Section of the Park <br />and Open Space Rules, and/or Section 0-2 of the Eugene Code, 1971, and/or ORS To wit, you: <br />Cju M i rvAL. --r1A5'S1S5 1 <br />(Description of the violation.) <br />This restriction of use is effective beginning onand 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 />armsted 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 48 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 these 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 Notice at the elate and time shown above by: <br />(Signature of person issuing/delivering notice) <br />1 hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />I N CU 3TK)Q'+ Sr( ! r& cD `7r-) <br />(Signature of person being issued the notice 07, 76, <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Guld Copy: officer Appeal notice Rev. 04/03 <br />