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