FS-2700-3e Special Use Application & Permit for Government Owned Bu

Auth ID: #AUTH_ID# FS-2700-3e (09/2020)

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

Expiration Date: #EXPIRATION_DATE#

Use Code: #USE_CODE#

USDA FOREST SERVICE SPECIAL USE APPLICATION AND PERMIT FOR

GOVERNMENT-OWNED BUILDINGS Authority: The Granger-Thye Act of April 24, 1950 (16 U.S.C. 572 and 580d)

Permission is hereby granted to:

Name of Holder:

Address:

Automobile Make:

License Number:

Telephone:

Number of People in Group:

Number of Pack or Saddle Stock:

Over-Snow Vehicles:

Other:

Herinafter called the holder, to subject to the conditions set out below, the following described Government-owned improvements located on the _________________________ National Forest:

FACILITY

# DAYS

FROM

TO

INSTRUCTIONS/RESTRICTIONS

Check-Out Time:

Maximum Party Size:

THIS PERMIT IS ACCEPTED SUBJECT TO THE CONDITIONS SET FORTH HEREIN.

IN CONSIDERATION FOR SUCH PERMISSION, I AGREE TO ABIDE BY THE TERMS OF THIS PERMIT AND THE RULES FOR OCCUPANCY OUTLINED BY THE AUTHORIZED OFFICERS, ATTACHED TO AND MADE A PART OF THIS PERMIT.

This permit is issued under the authority of the Granger-Thye Act of April 24, 1950. The holder agrees to pay a fee of

per day for a total of . The Forest Service, in accordance with the Granger-Thye Act, may use the fees to

perform necessary maintenance of the facility.

Holder’s Signature:		Date:
Authorized Officer’s Signature: ____________________________________________ Date: _______________

Terms and Conditions

1. This permit is non-refundable. Any changes to reserved dates must be made at least days prior to the original reservation.

2. The holder shall maintain the improvements and premise to standards of repair, orderliness, neatness, sanitation, and safety acceptable to the Forest Officer in charge. (See attached Rules for Occupancy.)

3. The holder, in exercising the privileges granted by this permit, shall comply with the regulations of the Department of Agriculture and all Federal, State, County and municipal laws, ordinances, or regulations which are applicable to the area of operations covered by this permit.

4. The holder shall take all reasonable precautions to prevent and suppress wildfires. No material shall be disposed of by burning in open fires during the closed season established by law or regulation without a written permit from the Forest Officer in charge or his authorized acting.

5. The holder shall exercise diligence in preventing damage to the land and other property of the United States covered by, and used in connection with this permit. The holder shall reimburse the United States for any damage of property, other than ordinary wear and tear, caused by the holder related to the occupancy of the facilities and the use of other property under the terms of this permit.

6. Avalanches, rising water, high winds, falling limbs or trees, and other hazards are natural phenomenon in the forest that presents risks, which the holder assumes. The holder assumes the responsibility of inspecting the site and immediate adjoining area for dangerous trees, hanging limbs, and other evidence of hazardous conditions and, after securing permission from the Forest Service, or removing such hazards.

7. The holder shall pack out and properly dispose of refuse, and shall not discharge waste or refuse into surface waters.

8. In the event of emergency rescue involving the holder or any other parties involved in the use, which require helicopter evacuation, the holder will be responsible for the cost of such rescue.

9. No fireworks shall be stored or used on the land covered by this permit, or in the structures thereon.

10. This permit shall not be exclusive. The Forest Service reserves the right to use or permit others to use any part of the permitted area for any purpose, provided such use does not interfere with the rights and privileges hereby authorized.

11. The holder shall indemnify the United States against any liability for damage to life or property arising from the holder’s occupancy or use of National Forest lands under this permit.

12. This permit is not transferable.

#INSERT TERM HERE#

Special Instructions/Restrictions:

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.  Response to this collection of information is mandatory. The authority to collect the information is the Organic Administration Act, 16 U.S.C. 551.  The time required to complete this information collection is estimated to average 15 minutes 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.

   

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs).  Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible agency or USDA’s TARGET Center at (202) 720-2600 (voice and TYY) or contact USDA through the Federal Relay Service at (800) 877-8339.  Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form.  To request a copy of the complaint form, call (866) 632-9992.  Submit your completed form or letter to USDA by: 
(1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. 

USDA is an equal opportunity provider, employer, and lender.

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.