Application and Permit - Private Sector

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OVERSIZE VEHICLE ATTACHMENT TO APPLICATION FOR A PERMIT
FOR USE OF ROADS RESTRICTED BY REGULATION OR ORDER

Authority:  16 U.S.C. 532-538
1. REASON FOR PERMIT

    TIMBER SALE:__________________________________________
    CONSTRUCTION CONTRACT:_____________________________
OTHER:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. DESIRED TRAVEL DATES AND ROUTES

     BEGINNING ON:____________________ ENDING ON:______________________
    DESIRED TRAVEL ROUTE (road #s, termini, and bridges crossed):___________________________________________________
____________________________________________________________________________________ ______________
__________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________________________________________________________
3. VEHICLE INFORMATION
VEHICLE CLASS
LENGTH
WIDTH
HEIGHT
LICENSE #
STATE
GVW ( in lbs.)











































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 0596-0016.  The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing road maps, 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 (800) 795-3272 (voice) or (202) 720-6382 (TDD).  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.
SIGNATURE OF APPLICANT


DATE
     




REPORT ON APPLICATION
(to be completed by Forest Service staff)

    1.  DESCRIPTION OF HAUL ROUTE (show roads on a map at a minimum scale of 1/2" equals one mile)
           

2.	ROAD CONDITION DATA
            

3.	DISCUSSION AND RECOMMENDATIONS
            

  DATE REPORT SUBMITTED

       
NAME AND SIGNATURE


TITLE

     

DATE REPORT APPROVED

     
NAME AND SIGNATURE
TITLE