Form FS-2300-43 Permit for Short-Term, Noncommercial use of Government-O

USDA Forest Service FS-2300-43 (2/2016)

OMB No. 0596-0106 (Expires XX/201X)

U.S. DEPARTMENT OF AGRICULTURE FOREST SERVICE

PERMIT FOR SHORT-TERM, NONCOMMERICAL USE OF GOVERNMENT-OWNED CABINS AND LOOKOUTS Authority: Federal Lands Recreation Enhancement Act, 16 U.S.C. 6801-6814

Name of Holder:

Address:

Automobile Make:

License Number:

Telephone:

Number of People in Group:

Number of Pack or Saddle Stock:

Over-Snow Vehicles:

Boats:

Other: ___________________________________________

Subject to the terms and conditions set out below, the holder is authorized to use the following federal improvements located in the _________________________ National Forest:

FACILITY

# DAYS

FROM

TO

INSTRUCTIONS/RESTRICTIONS

Check-Out Time:

Maximum Party Size:

TERMS AND CONDITIONS

1. This permit is issued under the Federal Lands Recreation Enhancement Act, 16 U.S.C. 6801-6814, and is subject to its provisions.

2. The authorized officer is the District Ranger or a subordinate official with delegated authority.

3. The holder shall pay a permit fee of $[ ] per day, for a total of $[ ].

4. In accordance with the Federal Lands Recreation Enhancement Act, the Forest Service may use the permit fee to perform repair, maintenance, and enhancement of the cabin or lookout that is directly related to visitor enjoyment, access, or health or safety.

5. The permit fee is non-refundable. Any changes to reserved dates must be made at least [ ] days prior to the original reservation.

6. This permit is a license for the use of federally owned land. This permit does not grant any interest in real property and is not transferable.

7. The use authorized by this permit is not exclusive. The Forest Service reserves the right to use or allow others to use the permitted area in any way that is not inconsistent with the holder’s privileges under this permit.

8. In exercising the privileges granted by this permit, the holder shall comply with all present and future federal laws and regulations and all present and future state, county, and municipal laws, regulations, and other legal requirements that apply to the permitted area, to the extent they do not conflict with federal law, regulation, or policy. 

9. The holder shall comply with the attached rules of occupancy, which are incorporated into this permit.

10. The holder shall take all reasonable precautions to prevent and suppress wildfires. No material shall be disposed of by burning in open fires during the closed season established by law or regulation without a written permit from the authorized officer or the authorized officer’s designated representative.

11. The holder shall exercise diligence in preventing damage to the National Forest System lands and federal property covered by this permit. The holder shall pay the United States for any property damage, other than ordinary wear and tear, caused by the holder in connection with the use authorized under the terms of this permit.

12. The holder assumes the responsibility of inspecting the authorized site and immediate adjoining area for dangerous trees, hanging limbs, and other evidence of hazardous conditions and, after securing permission from the authorized officer, of removing such hazards.

13. The holder shall pack out and properly dispose of refuse and shall not discharge waste or refuse into surface waters.

14. In the event of emergency rescue involving the holder or any persons accompanying the holder that requires helicopter evacuation, the holder shall be responsible for the cost of the rescue.

15. No fireworks shall be stored or used in the improvements or on the National Forest System lands covered by this permit.

16. The holder shall indemnify, defend, and hold harmless the United States for any costs, damages, claims, liabilitiies, and judgments arising from past, present, and future acts or omissions of the holder or the holder’s family, guests, and invitees in connection with the use authorized by this permit.

17. The holder acknowledges that use of a cabin or lookout on National Forest System lands involves inherent risks that may cause property damage, serious injury, and possibly death. Such risks include but are not limited to lightening or other weather conditions; avalanches, rising water, high winds, falling limbs or trees, and other hazards from natural phenomenons in a forest; unsafe conditions leading to or in the vicinity of a cabin or lookout; falls from ladders accessing lookouts; and exceeding the weight limit for a lookout. The holder voluntarily assumes full responsibility for damage and injury associated with these risks.

18. The holder waives, on behalf of the holder anad the holder’s reprsentatives, heirs, and assignees, any claims the holder may have against the United States and its officers, agents, and employees for property damage, personal injury, or death the holder may sustain as a result of or relating to the negligence of an officer, agent, or employee of the United States in connection with the holder’s use of the National Forest System lands and federal improvements covered by this permit.

Special Instructions/Restrictions:

This permit is accepted subject to all its terms and conditions.

Holder’s Name and Signature:		Date:
Authorized Officer’s Name, Title, and Signature: ____________________________________________ Date: _______________

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0106 The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer.

The Privacy Act of 1974 (5 U.S.C. 552a) and the Freedom of Information Act (5 U.S.C. 552) govern the confidentiality to be provided for information received by the Forest Service.

This information is needed by the Forest Service to evaluate requests to use National Forest System lands and manage those lands to protect natural resources, administer the use, and address public health and safety concerns. This information is required to obtain or retain a benefit. The authority for this information collection requirement is provided by the Federal Lands Recreation Enhancement Act.

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to United States Department of Agriculture, Clearance Officer, OCIO, AG Box 7630, Washington, D.C. 20250, and to the Office of Management and Budget, Paperwork Reduction Project (OMB #0596-0106), Washington, D.C. 20503.

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