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City of Eugene-Public Works <br /> Parks and Open Space <br /> 1820 Roosevelt 8Ivd. <br /> --\Eugene,OR 97402 <br /> Ph: (541)682-4800 _ <br /> Fax: (541)682-4882 Eugene <br /> RECEIPT <br /> Date: a <br /> Name: y, / v <br /> Quantity Description <br /> Standard Use Permit Application Fee (Non-Refundable) Fee: Circle$1 <br /> Special Use Permit Application Fee (Non-Refundable) $40 / $80 <br /> Security Deposit Fee(Refundable) <br /> $150 <br /> Other Fees _ / $10 / $25 <br /> l�{ ..L pc So / ,moo $ v, of <br /> /3/- 2650 - 3iO- V7?2o0 <br /> TOTAL Mil <br /> Payment: `Cash 0 Check# <br /> G Credit Card • <br /> Received by: Cr <br /> ���r <br /> • <br /> m -. vc1 <br /> T ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ a cn ID 0 coCco cr K <br /> co < co O C O O DDDR o 0 m m � o 2 m <br /> •in 7 m m <' m m a g1 8 S) , v w o , a,' o ° -e <br /> N - Tt �. .7i n- W CO E E n- m J7) -4 - v m <br /> CS D <br /> I> c" n `C tri N N tD N CD a .D to j Ell <br /> CO C <br /> N CO is <br /> "D CD N 'p CD <br /> 7 D o m <br /> N • -n o <br /> x 94 fu iv o 3 - ii p <br /> m m m 3Dma) to e/ }- <br /> tD 7 7 7 fD tD 7 - ❑ ❑ cS tD U1 <br /> x 3 W a)zz v v . 7. � �' m 0 <br /> X' �c — # 7 c91 two Ap to I M e <br /> V1 m C) N N I O O ` r <br /> r <br /> ---.S Ci) 1 0 <br /> Ji O (t) S1) I , <br /> 0 N p234, <br /> O C ( 69 N N O O ' l <br /> II) 01 `\ <br /> d • <br /> E e EA [i9 el 69 - e 69 t EA Hi Ha i tm <br /> t-"1 <br /> it <br /> W I ; N o ^I . <br />