Skip to Main Content
Do Not Show Again
I Want To...
Select a Category
Canines for Clean Water
Equity and Community Engagement
Eugene Sunday Streets
Family and Medical Leave
Fire and EMS Services
Parks and Open Space
PDD - BPS - Public Passenger Vehicles
PDD - Community Development
PDD - Recycling and Solid Waste
PDD Business and Economic Development
PDD Waste Prevention Sustainable Event Bins Reservation Form
Planning - Zoning and Land Use Forms
Planning - Zoning and Land Use Forms 3
Planning - Zoning and Land Use Forms 4
Planning- Zoning and Land Use Forms 2
Request Tracker Form
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)
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
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.
1. Requester/Property Owner Information
Type of property where smoking is currently prohibited
2. Requested Non-Smoking Location
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.
3. Impacts to Neighboring Properties
Are there designated smoking areas on your property?
If no, please attached a map, photograph, or diagram showing the neighboring properties where smoking is unrestricted.
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.
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
* indicates a required field
Meeting Materials and Webcasts
Mayor and City Council
Slideshow Left Arrow
Slideshow Right Arrow