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11, <br /> City of Eugene-Public Works <br /> Parks and Open Space <br /> 1820 Roosevelt BHd. <br /> Eugene,OR 97402 <br /> Ph: (541)6824800 Eugene • <br /> Fax: (541)682-4882 <br /> RECEIPT <br /> Date: 1• 17 <br /> Name: r\ &A_t, Pace 1 ee <br /> Quantity Description Fee: Circle One <br /> Standard Use Permit Application Fee (Non-Refundable) $11 / $30 <br /> n Special Use Permit Application Fee (Non-Refundable) � / $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 /> TOTAL $ ''1O. <br /> Payment: I- Cash /�yt (� i=�eck# /, O 5a =Credit Card <br /> r` Received by: G `J ✓ <br />