Form SF-299 Application for Transportation, Utility Systems, Telecom

STANDARD FORM 299
APPLICATION FOR TRANSPORTATION, UTILITY SYSTEMS, TELECOMMUNICATIONS AND FACILITIES
ON FEDERAL LANDS AND PROPERTY

NOTE: Before completing and filing the application for an authorization (easement, right-of-way, lease, license or permit), the

applicant should completely review this package, including instructions, and schedule a pre-application 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 pre-application meeting.

1. Name and address of applicant

2. Name and address of authorized agent if
different from item 1

FORM APPROVED
OMB Control Number:
Expiration Date:
FOR AGENCY USE ONLY
Application Number
Date Filed
3. Applicant telephone number and
email:

Authorized agent telephone number
and email:

4. As applicant are you? (check one)

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

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

a.
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 number
Amend existing authorization number
Assign existing authorization number
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 use or occupancy, (e.g., canal, pipeline, road, telecommunications); (b) related structures and
facilities; (c) physical specifications (Length, width, grading, etc.); (d) term of days/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 activity/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. Nonrefundable application fee:

Attached
Attached

Applied for
Not required

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

Not Required
To be determined by agency
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.

13a. Describe other alternative locations considered.

b. Why were these alternatives not selected?

c. Give explanation as to why it is necessary to use or occupy Federal assets (lands or buildings).

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; and, (g) historic or archaeological resources or properties.

18. Describe the probable effects that the proposed project will have on (a) populations of fish, plant life, 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, would be used, produced, transported or stored on or in a federal building or federal lands or would

be used in connection with the proposed use or occupancy. “Hazardous material” shall mean (a) any hazardous substance under section 101(14) of the
Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), 42 U.S.C. § 9601(14); (b) any pollutant or contaminant under section 101(33)
of CERCLA, 42 U.S.C. § 9601(33); (c) any petroleum product or its derivative, including fuel oil, and waste oils; and (d) any hazardous substance, extremely
hazardous substance, toxic substance, hazardous waste, ignitable, reactive or corrosive materials, pollutant, contaminant, element, compound, mixture, solution or
substance that may pose a present or potential hazard to human health or the environment under any applicable environmental laws. The holder shall not store any
hazardous materials at the site without prior written approval from the authorized officer. This approval shall not be unreasonably withheld. If the authorized officer
provides approval, this permit shall include (or in the case of approval provided after this permit is issued, shall be amended to include) specific terms addressing the
storage of hazardous materials, including the specific type of materials to be stored, the volume, the type of storage, and a spill plan. Such terms shall be proposed
by the holder and are subject to approval by the authorized officer.

20. Name all the Federal 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.

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 utility systems telecommunication installations
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.
4. Systems for the transmission and distribution of electric energy.

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, utility systems, telecommunication
installations 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.
SPECIFIC INSTRUCTIONS
(Items not listed are self-explanatory)

5. Wired and wireless systems for transmission or reception of radio,
television, telephone, telegraph, and other electronic signals, and other
means of communications.

7

6. Improved right-of-way for snow machines, air cushion vehicles, and allterrain vehicles.

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.

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)
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)
Alaska Regional Office
709 West 9th Street
Juneau, Alaska 99802
Telephone: (907) 586-7177

13 Providing information on alternate locations in as much detail as
possible, discussing why certain locations were rejected and why it is
necessary to use Federal assets will assist the agency(ies) in
processing your application and reaching a final decision. Include
only reasonable alternate locations 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 with 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.

Department of the Interior
Alaska State Office
Bureau of Land Management
222 West 7th Avenue #13
Anchorage, Alaska 99513
Public Room: 907-271-5960
FAX: 907-271-3684
(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

9, 10, and 12 The responsible agency will provide additional instructions.

Application must be signed by the applicant or applicant's authorized
representative.

National Park Service (NPS)
Alaska Regional Office
240 West 5th Avenue
Anchorage, Alaska 99501
Telephone: (907) 644-3510

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 Officer, P.O. Box 120, 1675 C Street, Anchorage, Alaska
99513.

EFFECT OF NOT PROVIDING INFORMATION
Disclosure of the information is voluntary. If all the information is not provided, the proposal or application may be rejected.
DATA COLLECTION STATEMENT
The Federal agencies collect this information from proponents and applicants requesting a right-of-way, permit, license, lease, or certification for use of
Federal assets. The Federal agencies use this information to evaluate a proponent’s or applicant’s proposal to use Federal assets.
BURDEN 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-XXXX. The time required to
complete this information collection is estimated to average 8 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 authority to collect this information is
derived from 47 U.S.C. 1455(c)(3) and 16 U.S.C. 3210.

USDA NONDISCRIMNATION STATEMENT
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.

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

CHECK APPROPRIATE
BLOCK
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.