FS-2700-25 Temporary Special Use Permit

Authorization ID: #AUTH_ID#                                                                                         FS-2700-25 (REV-02/17)

Contact ID: #HOLDER_ID#                                                                                                   OMB NO. 0596-0082

Expiration Date: #EXPIRATION_DATE#

Use Code: #USE_CODE#

U.S. DEPARTMENT OF AGRICULTURE

FOREST SERVICE

TEMPORARY SPECIAL - USE PERMIT

AUTHORITY:

#AUTHORITY_NAME#

 

 

#HOLDER_NAME#, hereinafter called the Holder, is hereby authorized to use, subject to the terms and conditions of this permit, National Forest System land identified within the unit area and described as #TOWNSHIP_SECT_RANGE# #FIRST_DIVISION# #FIRST_DIV_NAME_NUMBER#, #SECOND_DIVISION# #SECOND_DIV_NAME_NUMBER#, #THIRD_DIVISION# #THIRD_DIV_NAME_NUMBER# as shown on the attached Exhibit(s) .  This authorization covers approximately #USE_ACRES# acres and/or #USE_MILES# miles.

 

The holder is authorized to conduct the following activities and/ or install the following temporary improvements on the permitted area:

 

#PURPOSE#

 

TERMS AND CONDITIONS

 

1.  Use under this permit shall begin on and end on #EXPIRATION_DATE#. The permit shall not be extended.

 

2.   The fee for this use is It shall be paid in advance and is not refundable.

 

3.  The holder shall conduct the authorized activities according to the attached approved plans and specifications, Exhibit(s) .

 

4.   The holder shall not install any improvements not specifically identified and approved above.

 

5.  No soil, trees, or other vegetation may be destroyed or removed from National Forest System lands without specific prior written permission from the authorized officer.

 

6.  The holder shall comply with all Federal, State, county, and municipal laws, ordinances, and regulations which are applicable to the area or operations covered by this permit.

 

7.  The holder shall maintain the improvements and premises to standards of repair, orderliness, neatness, sanitation, and safety acceptable to the authorized officer.  The holder shall fully repair and bear the expense for all damage, other than ordinary wear and tear, to National Forest System lands, roads and trails caused by the holder's activities.

 

8.  The holder has the responsibility of inspecting the use area and adjoining areas for dangerous trees, hanging limbs, and other evidence of hazardous conditions which would pose a risk of injury to individuals.  After securing permission from the authorized officer, the holder shall remove such hazards.

 

9.  The holder shall be liable for any damage suffered by the United States resulting from or related to use of this permit, including damages to National Forest resources and costs of fire suppression.

 

10.  The holder shall hold harmless the United States from any liability from damage to life or property arising from the holder's occupancy or use of National Forest lands under this permit.

 

11.  The holder agrees to permit the free and unrestricted access to and upon the premises at all times for all lawful and proper purposes not inconsistent with the intent of the permit or with the reasonable exercise and enjoyment by the holder of the privileges thereof.

 

12.  This permit is subject to all valid existing rights and claims outstanding in third parties.

 

13.  This permit may be revoked upon breach of any of the conditions herein or at the discretion of the authorized officer.  Upon expiration or revocation of this permit, the holder shall immediately remove all improvements except those owned by the United States, and shall restore the site within day(s), unless otherwise agreed upon in writing.  If the holder fails to remove the improvements, they shall become the property of the United States, but that will not relieve the holder of liability for the cost of their removal and restoration of the site.

 

14.  This permit is a license for the use of federally owned land.  It does not grant any interest in real property.  This permit is not transferable.  The holder shall not enter into any agreements with third parties for occupancy of the authorized premises and improvements.

 

15.  Appeal of any provisions of this permit or any requirements thereof shall be subject to the appeal regulations at 36 CFR 251, Subpart C, or revisions thereof.

 

16.  This permit is accepted subject to the conditions set forth herein, condition(s) and Exhibit(s) attached to and made a part of this permit.

 

17.  The above clauses shall control if they conflict with additional clauses or provisions.

 

#INSERT TERM HERE#

 

 

I have read and understand the terms and conditions and agree to abide by them.

 

HOLDER                                                                             U. S. DEPARTMENT OF AGRICULTURE

                                                                                          Forest Service

 

By:                                                                                     By:                                                                                                                           

 

Address:                                                                             Name:    

 

                                                                                          Title:                               

(Authorized Officer)

Phone #:                                                    

 

Date:                                                                                  Date:                                                   

 

 Burden and Non-Discrimination Statement

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 one(1) hour 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.