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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />►ATE: /��� TIME: 1 3 �, CASE #: <br />,L , c- -,�- <br />f Z--2�� <br />_ 2 1 r2-5 <br />,OCATION (PARK/OPEN SPACE): WT-6 M V = 4�., <br />H <br />Name: Last first Middle <br />DOB: <br />Race /Se <br />� <br />Re .address: � � 1 C � City <br />State <br />Zi <br />Res. Phone: <br />Work P nC <br />2,J ........ . .. <br />� <br />Ender the authority of Administrative Order No. 58- 03 -24 -F and Park and Open Space Rule R- 1.005(3), you are hereby <br />otified that you are prohibited from (check box): <br />ZV Entering in or using all City of Eugene parks, open spaces or facilities. <br />he basis for this Notice of Restriction of Use is that on — 0691 you violated Section of the Park <br />ad Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS 7.'�: Jl � *it, you: <br />c <br />description of the violation.) <br />`his restriction of use is effective beginning on ! , and shall remain in effect until 0 101 r Z-! <br />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 />crested and charged with criminal trespass in the second degree. <br />ursuant 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 />iformal 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 />7402. <br />he Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />2 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />insider testimony from you, City personnel involved in the incident that resulted in this Notice, and.other witnesses to the <br />icident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. <br />'his Notice shall remain in effect pending any requested hearing. <br />his Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />CnL.-zo <br />(Signature of erson issuing /delivering notice) <br />hereby acknowledge receipt of the above Notice on the date and time indic <br />Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice <br />Rev. 04/03 <br />�j <br />