Online Forms

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Request to Prohibit Smoking on Adjacent Rights-of-Way (Opt-In Request)

  1. Please use this form to request non-smoking locations on adjacent public rights-of-way for properties that are places of employment outside of the downtown core.

    *There are no fees associated with this request.

  2. 1. Requester/Property Owner Information

  3. Please attach a map, photograph, or diagram showing the right-of-way area(s) adjacent to the property where you are requesting that people be prohibited from smoking.

  4. 3. Impacts to Neighboring Properties*

    Are there designated smoking areas on your property?

  5. If no, please attached a map, photograph, or diagram showing the neighboring properties where smoking is unrestricted.

  6. 4. Electronic Signature

    I certify that I am the owner or an authorized representative of the above-referenced property. I acknowledge that the City approving my request to prohibit smoking on adjacent rights-of-way does not alleviate my responsibility to comply with all other applicable local and state laws, including Eugene Code 6.225 – 6.240 and Administrative Order No. 21-18-07. I also acknowledge that the City approving my request to prohibit smoking on adjacent rights-of-way does not obligate the City, including the Eugene Police Department, to take any specific action to enforce the approved smoking prohibition.

  7. Leave This Blank:

  8. This field is not part of the form submission.