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City of Eugene—Public Works pA-r5 tjI- 3 `j 3Parks and Open Space <br /> 1820 Roosevelt Blvd. <br /> Eugene,OR 97402 <br /> Ph: (541)682-4800 Eugene <br /> Fax: (541)682-4882 <br /> C� RECEIPT <br /> Date: / / • <br /> • <br /> Name: k1-eh • S ca, <br /> Quantity Description Fee: Circle One <br /> Standard Use Permit Application Fee (Non-Refundable) $15 / $30 <br /> Special Use Permit Application Fee (Non-Refundable) $40 / $80 <br /> Facility Fee or General Use Fee $ <br /> Security Deposit Fee (Refundable) $150 <br /> Vehicle Access Permit Fee $10 / $25 <br /> Other Fees <br /> EarA /p/o <br /> $ <br /> -f+ TOTAL $ <br /> Payment: C. h Check# -t Card <br /> Received by: I %j O. <br />