FS-7700-40a Commercial use Attachment to Application to Application

U.S. Department of Agriculture FS-7700-0040a (v07/2013)

U.S. Forest Service OMB no. 0596-0016 (exp. date )

COMMERCIAL USE ATTACHMENT TO APPLICATION FOR A PERMIT

FOR USE OF ROADS RESTRICTED BY REGULATION OR ORDER

Authority: 16 U.S.C. 532-538

1. PURPOSE OF USE HAULING LOGS OR LUMBER: approximately       MBF HAULING OTHER MATERIALS: approximately       tons DESCRIBE OTHER MATERIALS:      
2. USE SCHEDULE NUMBER OF DAYS TYPE OF TRUCKS TYPE OF LOADING SEASON OF USE TO BE USED TO BE USED                                                                                                
3. PLANS FOR FUTURE USE (not included in this application) HAULING LOGS OR LUMBER: approximately       MBF HAULING OTHER MATERIALS: approximately       tons DESCRIBE MATERIALS:       ESTIMATED PERIOD OF USE: from       to      
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 and approved by district ranger)
	GENERAL DESCRIPTION OF ROADS TO BE USED AND THEIR SUITABILITY FOR THE PROPOSED USE (show roads on a map at a minimum scale of 1/2" equals one mile)      
	2. IMPROVEMENTS NEEDED TO ROADS TO SAFELY ACCOMMODATE THE APPLICANT’S TRAFFIC      
	3. OTHER DESIRED IMPROVEMENTS TO ROADS      
	DATE REPORT SUBMITTED      	NAME AND SIGNATURE	TITLE      
	DATE REPORT APPROVED      	NAME AND SIGNATURE	TITLE      

Page 1 of 1