Form SF-299 Application for Transportation and Utility Systems and F

STANDARD FORM 299 (05/2009)
Prescribed by DOI/USDA/DOT
P.L. 96-487 and Federal
Register Notice 5-22-95

APPLICATION FOR TRANSPORTATION AND
UTILITY SYSTEMS AND FACILITIES
ON FEDERAL LANDS

FORM APPROVED
OMB Control Number: 0596-0082
Expiration Date: 1/31/2017
FOR AGENCY USE ONLY

NOTE: Before completing and filing the application, the applicant should completely review this package and schedule a

Application Number

preapplication meeting with representatives of the agency responsible for processing the application. Each agency may have
specific and unique requirements to be met in preparing and processing the application. Many times, with the help of the agency
representative, the application can be completed at the preapplication meeting.

1. Name and address of applicant (include zip code)

2. Name, title, and address of authorized agent if
different from item 1 (include zip code)

Date Filed
3. Telephone (area code)
Applicant
Authorized Agent

4. As applicant are you? (check one)

5. Specify what application is for: (check one)

a.

a.
b.
c.
d.
e.
f.

b.
c.
d.
e.
f.

Individual
Corporation*
Partnership/Association*
State Government/State Agency
Local Government
Federal Agency

* If checked, complete supplemental page

New authorization
Renewing existing authorization No.
Amend existing authorization No.
Assign existing authorization No.
Existing use for which no authorization has been received *
Other*

* If checked, provide details under item 7

6. If an individual, or partnership are you a citizen(s) of the United States?

Yes

No

7. Project description (describe in detail): (a) Type of system or facility, (e.g., canal, pipeline, road); (b) related structures and facilities; (c) physical
specifications (Length, width, grading, etc.); (d) term of years needed: (e) time of year of use or operation; (f) Volume or amount of product to be
transported; (g) duration and timing of construction; and (h) temporary work areas needed for construction (Attach additional sheets, if additional
space is needed.)

8. Attach a map covering area and show location of project proposal
9. State or Local government approval:
10. Nonreturnable application fee:

Attached
Attached

Applied for

Not Required

Not required

11. Does project cross international boundary or affect international waterways?

Yes

No

(if "yes," indicate on map)

12. Give statement of your technical and financial capability to construct, operate, maintain, and terminate system for which authorization is being
requested.

STANDARD FORM 299 (REV. 5/2009)

13a. Describe other reasonable alternative routes and modes considered.

b. Why were these alternatives not selected?

c. Give explanation as t o why it is necessary to cross Federal Lands.

14. List authorizations and pending applications filed for similar projects which may provide information to the authorizing agency. (Specify number,
date, code, or name)

15. Provide statement of need for project, including the economic feasibility and items such as: (a) cost of proposal (construction, operation, and
maintenance); (b) estimated cost of next best alternative; and (c) expected public benefits.

16. Describe probable effects on the population in the area, including the social and economic aspects, and the rural lifestyles.

17. Describe likely environmental effects that the proposed project will have on: (a) air quality; (b) visual impact; (c) surface and ground water quality
and quantity; (d) the control or structural change on any stream or other body of water; (e) existing noise levels; and (f) the surface of the land,
including vegetation, permafrost, soil, and soil stability.

18. Describe the probable effects that the proposed project will have on (a) populations of fish, plantlife, wildlife, and marine life, including threatened
and endangered species; and (b) marine mammals, including hunting, capturing, collecting, or killing these animals.

19. State whether any hazardous material, as defined in this paragraph, will be used, produced, transported or stored on or within the right-of-way or
any of the right-of-way facilities, or used in the construction, operation, maintenance or termination of the right-of-way or any of its facilities.
"Hazardous material" means any substance, pollutant or contaminant that is listed as hazardous under the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980, as amended, 42 U.S.C. 9601 et seq., and its regulations. The definition of hazardous
substances under CERCLA includes any "hazardous waste" as defined in the Resource Conservation and Recovery Act of 1976 (RCRA), as
amended, 42 U.S.C. 6901 et seq., and its regulations. The term hazardous materials also includes any nuclear or byproduct material as defined
by the Atomic Energy Act of 1954, as amended, 42 U.S.C. 2011 et seq. The term does not include petroleum, including crude oil or any fraction
thereof that is not otherwise specifically listed or designated as a hazardous substance under CERClA Section 101(14), 42 U.S.C. 9601(14), nor
does the term include natural gas.

20. Name all the Department(s)/Agency(ies) where this application is being filed.

I HEREBY CERTIFY, That I am of legal age and authorized to do business in the State and that I have personally examined the information contained
in the application and believe that the information submitted is correct to the best of my knowledge.
Signature of Applicant

Date

Title 18, U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any
false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.

STANDARD FORM 299 (REV. 5/2009) PAGE 2

Department of Transportation
Federal Aviation Administration
Alaska Region AAL-4, 222 West 7th Ave., Box 14
Anchorage, Alaska 99513-7587
Telephone: (907) 271-5285

GENERAL INFORMATION
ALASKA NATIONAL INTEREST LANDS
This application will be used when applying for a right-of-way, permit,
license, lease, or certificate for the use of Federal lands which lie within
conservation system units and National Recreation or Conservation Areas
as defined in the Alaska National Interest lands Conservation Act.
Conservation system units include the National Park System, National
Wildlife Refuge System, National Wild and Scenic Rivers System,
National Trails System, National Wilderness Preservation System, and
National Forest Monuments.
Transportation and utility systems and facility uses for which the
application may be used are:
1. Canals, ditches, flumes, laterals, pipes, pipelines, tunnels, and other
systems for the transportation of water.
2. Pipelines and other systems for the transportation of liquids other than
water, including oil, natural gas, synthetic liquid and gaseous fuels, and
any refined product produced therefrom.
3. Pipelines, slurry and emulsion systems, and conveyor belts for
transportation of solid materials.

NOTE - The Department of Transportation has established the above
central filing point for agencies within that Department. Affected agencies
are: Federal Aviation Administration (FAA), Coast Guard (USCG), Federal
Highway Administration (FHWA), Federal Railroad Administration (FRA).
OTHER THAN ALASKA NATIONAL INTEREST LANDS
Use of this form is not limited to National Interest Conservation Lands of
Alaska.
Individual department/agencies may authorize the use of this form by
applicants for transportation and utility systems and facilities on other
Federal lands outside those areas described above.
For proposals located outside of Alaska, applications will be filed at the
local agency office or at a location specified by the responsible Federal
agency.

4. Systems for the transmission and distribution of electric energy.
5. Systems for transmission or reception of radio, television, telephone,
telegraph, and other electronic signals, and other means of
communications.
6. Improved right-of-way for snow machines, air cushion vehicles, and allterrain vehicles.
7. Roads, highways, railroads, tunnels, tramways, airports, landing strips,
docks, and other systems of general transportation.
This application must be filed simultaneously with each Federal
department or agency requiring authorization to establish and operate
your proposal.
In Alaska, the following agencies will help the applicant file an application
and identify the other agencies the applicant should contact and possibly
file with:
Department of Agriculture
Regional Forester, Forest Service (USFS)
Federal Office Building,
P.O. Box 21628
Juneau, Alaska 99802-1628
Telephone: (907) 586-7847 (or a local Forest Service Office)
Department of the Interior
Bureau of Indian Affairs (BIA)
Juneau Area Office
Federal Building Annex
9109 Mendenhall Mall Road, Suite 5
Juneau, Alaska 99802
Telephone: (907) 586-7177
Department of the Interior
Bureau of Land Management
222 West 7th Avenue
P.O. Box 13
Anchorage, Alaska 99513-7599
Telephone: (907) 271-5477 (or a local BLM Office)
U.S. Fish & Wildlife Service (FWS)
Office of the Regional Director
1011 East Tudor Road
Anchorage, Alaska 99503
Telephone: (907) 786-3440

National Park Service (NPA)
Alaska Regional Office, 2225
Gambell St., Rm. 107
Anchorage, Alaska 99502-2892
Telephone: (907) 786-3440

Note - Filings with any Interior agency may be filed with any office noted
above or with the Office of the Secretary of the Interior, Regional
Environmental Office, P.O. Box 120, 1675 C Street, Anchorage, Alaska
9513.

SPECIFIC INSTRUCTIONS
(Items not listed are self-explanatory)
7

Attach preliminary site and facility construction plans. The responsible
agency will provide instructions whenever specific plans are required.

8

Generally, the map must show the section(s), township(s), and
range(s) within which the project is to be located. Show the proposed
location of the project on the map as accurately as possible. Some
agencies require detailed survey maps. The responsible agency will
provide additional instructions.

9 , 10, and 12 The responsible agency will provide additional instructions.
13 Providing information on alternate routes and modes in as much detail
as possible, discussing why certain routes or modes were rejected
and why it is necessary to cross Federal lands will assist the
agency(ies) in processing your application and reaching a final
decision. Include only reasonable alternate routes and modes as
related to current technology and economics.
14 The responsible agency will provide instructions.
15 Generally, a simple statement of the purpose of the proposal will be
sufficient. However, major proposals located in critical or sensitive
areas may require a full analysis with additional specific information.
The responsible agency will provide additional instructions.
16 through 19 Providing this information is as much detail as possible will
assist the Federal agency(ies) in processing the application and
reaching a decision. When completing these items, you should use a
sound judgment in furnishing relevant information. For example, if the
project is not near a stream or other body of water, do not address this
subject. The responsible agency will provide additional instructions.
Application must be signed by the applicant or applicant's authorized
representative.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the
information is voluntary. If all the information is not provided, the
application may be rejected.
DATA COLLECTION STATEMENT
The Federal agencies collect this information from applicants requesting
right-of-way, permit, license, lease, or certification for the use of Federal
lands. The Federal agencies use this information to evaluate the
applicant's proposal. The public is obligated to submit this form if they wish
to obtain permission to use Federal lands.

STANDARD FORM 299 (REV. 5/2009) PAGE 3

SUPPLEMENTAL
CHECK APPROPRIATE
BLOCK

NOTE: The responsible agency(ies) will provide instructions
I - PRIVATE CORPORATIONS

ATTACHED

FILED*

a. Articles of Incorporation
b. Corporation Bylaws
c. A certification from the State showing the corporation is in good standing and is entitled to operate within the State
d Copy of resolution authorizing filing
e. The name and address of each shareholder owning 3 percent or more of the shares, together with the number and
percentage of any class of voting shares of the entity which such shareholder is authorized to vote and the name and
address of each affiliate of the entity together with, in the case of an affiliate controlled by the entity, the number of
shares and the percentage of any class of voting stock of that affiliate owned, directly or indirectly, by that entity, and
in the case of an affiliate which controls that entity, the number of shares and the percentage of any class of voting
stock of that entity owned, directly or indirectly, by the affiliate.
f. If application is for an oil or gas pipeline, describe any related right- of-way or temporary use permit applications,
and identify previous applications.
g. If application is for an oil and gas pipeline, identify all Federal lands by agency impacted by proposal.
II - PUBLIC CORPORATIONS
a. Copy of law forming corporation
b. Proof of organization
c. Copy of Bylaws
d. Copy of resolution authorizing filing
e. If application is for an oil or gas pipeline, provide information required by item "I - f" and "I - g" above.
III - PARTNERSHIP OR OTHER UNINCORPORATED ENTITY
a. Articles of association, if any
b. If one partner is authorized to sign, resolution authorizing action is
c. Name and address of each participant, partner, association, or other
d. If application is for an oil or gas pipeline, provide information required by item "I - f" and "I - g" above.
*If the required information is already filed with the agency processing this application and is current, check block entitled "Filed." Provide the file
identification information (e.g., number, date, code, name). If not on file or current, attach the requested information.

STANDARD FORM 299 (REV. 5/2009) PAGE 4

NOTICES
Note: This applies to the Department of Agriculture/Forest Service (FS)
This information is needed by the Forest Service to evaluate the requests to use National Forest
System lands and manage those lands to protect natural resources, administer the use, and ensure
public health and safety. This information is required to obtain or retain a benefit. The authority for
that requirement is provided by the Organic Act of 1897 and the Federal Land Policy and
Management Act of 1976, which authorize the secretary of Agriculture to promulgate rules and
regulations for authorizing and managing National Forest System lands. These statutes, along with
the Term Permit Act, National Forest Ski Area Permit Act, Granger-Thye Act, Mineral Leasing Act,
Alaska Term Permit Act, Act of September 3, 1954, Wilderness Act, National Forest Roads and Trails
Act, Act of November 16, 1973, Archeological Resources Protection Act, and Alaska National Interest
Lands Conservation Act, authorize the Secretary of Agriculture to issue authorizations or the use and
occupancy of National Forest System lands. The Secretary of Agriculture's regulations at 36 CFR
Part 251, Subpart B, establish procedures for issuing those authorizations.
BURDEN AND NONDISCRIMINATION STATEMENTS
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 0596-0082. The time required
to complete this information collection is estimated to average 8 hours hours 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, age, disability, and where applicable, sex, marital status,
familial status, parental status, religion, sexual orientation, genetic information, political beliefs,
reprisal, or because all or part of an individual’s income is derived from any public assistance. (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 toll free (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.

STANDARD FORM 299 (REV. 5/2009) PAGE 5