Sample Permit Conditions for Improvements or Alterations

OMB Control No. 1018-####

Expires ##/##/20##

Special Conditions – Dugout Construction/Cleanout

1. Any additional permits and/or permission required for this action (County, State, Federal Agencies i.e. farm bill) are the responsibilities of the landowner. Permission from upstream or downstream landowners/township boards and adjacent landowners permission are the responsibilities of the landowner. The USFWS will NOT be held liable for any damages caused by this action.

2. The dugout is to be constructed in the location as shown on the attached map and/or as staked in the field. Removing additional material beyond what has been approved may result in wetland easement related violations.

3. Spoil is to be placed outside of the wetland basin, and can be leveled so long as it is not used to fill other wetland basins.

4. Side slopes should be constructed at a 3:1 ratio. USDA/NRCS specifications should be followed.

5. Future cleanout of the dugout will require an additional permit.

Paperwork Reduction Act Statement: We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501, et seq.) to evaluate requests to improve or make alterations on easement lands. Your response is required to obtain or retain a benefit. We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB Control Number. OMB has reviewed and approved this focus group and assigned OMB Control Number 1090-0011.

Estimated Burden Statement: We estimate it will take 15 minutes to complete this survey, including time to read instructions and gather information. You may submit comments on any aspect of this information collection to the Service Information Collection Clearance Officer, U.S. Fish and Wildlife Service, 5275 Leesburg Pike, MS: PRB (JAO/3W), Falls Church, VA 22041-3803, or via email at [email protected].