FS-2700-4 Special Use Permit

Special Use Administration

FS-2700-4 Special Use Permit

OMB: 0596-0082

Document [pdf]

Download: pdf | pdf

Authorization ID: #AUTH_ID#
Contact ID: #HOLDER_ID#
Expiration Date: #EXPIRATION_DATE#
Use Code: #USE_CODE#

FS-2700-4 (XX/202X)
OMB 0596-0082

U.S. DEPARTMENT OF AGRICULTURE
FOREST SERVICE
SPECIAL USE PERMIT
AUTHORITY:
#AUTHORITY_NAME#

#HOLDER_NAME# of #HOLDER_ADD_LINE_1#, #HOLDER_ADD_LINE_2#, #HOLDER_ADD_LINE_3#,
#HOLDER_CITY#, #HOLDER_STATE# #HOLDER_ZIP# (hereinafter “the holder”) is authorized to use or occupy
National Forest System lands in the __________ National Forest or ____________ unit of the National Forest
System, subject to the terms of this special use permit (permit).

This permit covers #USE_ACRES# acres or #USE_MILES# miles in the #TOWNSHIP_SECT_RANGE#
#FIRST_DIVISION# #FIRST_DIV_NAME_NUMBER#, #SECOND_DIVISION#
SECOND_DIV_NAME_NUMBER#, #THIRD_DIVISION# #THIRD_DIV_NAME_NUMBER# (“the permit area”), as
shown on the map in Appendix A. This and any other appendices to this permit are hereby incorporated into this
permit.
This permit is issued for the purpose of:
#PURPOSE#

D
R

I. GENERAL TERMS

A. AUTHORITY. This permit is issued pursuant to [name of and cite for authority] and 36 CFR Part 251,
Subpart B, as amended, and is subject to their provisions.
B. AUTHORIZED OFFICER. The authorized officer is the Forest or Grassland Supervisor, a District Ranger, or
the Station, Institute, or Area Director with delegated authority pursuant to Forest Service Manual 2700.
C. TERM. This permit shall expire at midnight on #EXPIRATION_DATE#. Expiration of this permit shall
not require notice, a decision document, or any environmental analysis or other documentation.
D. CONTINUATION OF USE AND OCCUPANCY. This permit is not renewable. Prior to expiration of this
permit, the holder may apply for a new permit for the use and occupancy authorized by this permit. Applications
for a new permit must be submitted at least 6 months prior to expiration of this permit. Issuance of a new permit
is at the sole discretion of the authorized officer. At a minimum, before issuing a new permit, the authorized
officer shall ensure that (1) the use and occupancy to be authorized by the new permit are consistent with the
direction in the applicable land management plan; (2) the type of use and occupancy to be authorized by the new
permit is the same as the type of use and occupancy authorized by this permit; and (3) the holder is in compliance
with all the terms of this permit. The authorized officer may prescribe new terms when a new permit is issued.
E. AMENDMENT. This permit may be amended in whole or in part by the Forest Service when, at the discretion
of the authorized officer, such action is deemed necessary or desirable to incorporate new terms that may be
required by law, regulation, directive, the applicable land management plan, or projects and activities
implementing the land management plan pursuant to 36 CFR Part 218. Any amendments to this permit under
this clause must be in writing and must be signed and dated by the authorized officer.
Page 1 of 17

F. COMPLIANCE WITH LAWS, REGULATIONS, AND OTHER LEGAL REQUIREMENTS. In exercising the
rights and privileges granted by this permit, the holder shall comply with all present and future federal laws and
regulations and all present and future state, county, and municipal laws, regulations, and other legal requirements
that apply to the permit area, to the extent they do not conflict with federal law, regulation, or policy. The Forest
Service assumes no responsibility for enforcing laws, regulations, and other legal requirements that fall under the
jurisdiction of other governmental entities.
G. NON-EXCLUSIVE USE. The use or occupancy authorized by this permit is not exclusive. The Forest
Service reserves the right of access to the permit area, including a continuing right of physical entry to the permit
area and the authorized facilities and improvements for inspection, monitoring, or any other purpose consistent
with any right or obligation of the United States under any law or regulation. The Forest Service reserves the right
to allow others to use the permit area in any way that is not inconsistent with the holder's rights and privileges
under this permit, after consultation with all parties involved. Except for any restrictions that the holder and the
authorized officer agree are necessary to protect the installation and operation of authorized temporary
improvements, the lands and waters covered by this permit shall remain open to the public for all lawful
purposes.
H. ASSIGNABILITY. This permit is not assignable or transferable.

TRANSFER OF TITLE TO THE IMPROVEMENTS

1. Notification of Transfer. The holder shall notify the authorized officer when a transfer of title to all or part of
the authorized improvements is planned.
2. Transfer of Title. Any transfer of title to the improvements covered by this permit shall result in termination of
the permit upon issuance of a new permit to another party for the use and occupancy authorized by this permit.
The party who acquires title to the improvements must submit an application for a permit. The Forest Service is
not obligated to issue a new permit to the party who acquires title to the improvements. The authorized officer
shall determine that the applicant meets requirements under applicable federal regulations.

D
R

J. CHANGE IN CONTROL OF THE BUSINESS ENTITY
1. Notification of Change in Control. The holder shall notify the authorized officer when a change in control of the
business entity that holds this permit is planned.
(a) In the case of a corporation, control is an interest, beneficial or otherwise, of sufficient outstanding voting
securities or capital of the business so as to permit the exercise of managerial authority over the actions and
operations of the corporation or election of a majority of the board of directors of the corporation.
(b) In the case of a partnership, limited partnership, joint venture, or individual entrepreneurship, control is a
beneficial ownership of or interest in the entity or its capital so as to permit the exercise of managerial authority
over the actions and operations of the entity.
(c) In other circumstances, control is any arrangement under which a third party has the ability to exercise
management authority over the actions or operations of the business.
2. Effect of Change in Control. Any change in control of the business entity as defined in paragraph 1 of this
clause shall result in termination of this permit upon issuance of a new permit to another party for the use and
occupancy authorized by this permit. The party acquiring control must submit an application for a special use
permit. The Forest Service is not obligated to issue a new permit to the party who acquires control. The
Page 2 of 17

authorized officer shall determine whether the applicant meets the requirements established by applicable federal
regulations.

K. CONVEYANCE OF LANDS COVERED BY THIS PERMIT. The authorized officer shall give the holder at
least 90 days prior written notice of any pending conveyance of the lands covered by this permit. With the
holder’s consent, the Forest Service may convey the lands covered by this permit without reserving the right-ofway granted by this permit. If the holder does not consent to conveyance without reservation of the right-of-way,
the Forest Service may convey the lands covered by this permit only if the lands are subject to the right-of-way
granted by this permit.

L. TERMINATION UPON A CHANGE IN THE AUTHORIZED USE AND OCCCUPANCY. This permit shall
terminate when the permit area ceases to be used for the purpose authorized by this permit (43 U.S.C. 931c).
II. IMPROVEMENTS

A. LIMITATIONS ON USE. Nothing in this permit gives or implies permission to build or maintain any structure
or facility or to conduct any activity, unless specifically authorized by this permit. Any use not specifically
authorized by this permit must be proposed in accordance with 36 CFR 251.54 or 251.61. Approval of such a
proposed use through issuance of a new permit or permit amendment is at the sole discretion of the authorized
officer.

D
R

B. DRAWINGS. All drawings for development, layout, construction, reconstruction, or alteration of
improvements in the permit area, as well as revisions to those drawings, must be prepared by a professional
engineer, architect, landscape architect, or other qualified professional acceptable to the authorized officer.
These drawings and drawing revisions must have written approval from the authorized officer before they are
implemented. The authorized officer may require the holder to furnish as-built drawings, maps, or surveys upon
completion of the work.
C. CONSTRUCTION. Any construction authorized by this permit shall commence by ______ and shall be
completed by ____________.
D. RELOCATION. This permit is issued with the express understanding that should future location of federally
owned improvements or road rights-of-way require relocation of the holder’s improvements, the relocation will be
conducted by and at the expense of the holder within a reasonable period specified by the authorized officer.
III. OPERATIONS
A. PERIOD OF USE. Use or occupancy of the permit area shall be exercised at least __________ days each
year.
B. CONDITION OF OPERATIONS. The holder shall maintain the authorized improvements and permit area to
standards of repair, orderliness, neatness, sanitation, and safety acceptable to the authorized officer and
consistent with other provisions of this permit. Standards are subject to periodic change by the authorized officer
when deemed necessary to meet statutory, regulatory, or policy requirements or to protect National Forest
System resources.
C. USE OF NATIONAL FOREST SYSTEM ROADS AND NATIONAL FOREST SYSTEM TRAILS. The
holder’s use of National Forest System roads and National Forest System trails shall comply with applicable
requirements in 36 CFR Part 212, Subpart A; 36 CFR Part 261, Subpart A; and orders issued under 36 CFR Part
261, Subpart B. Motor vehicle use shall be consistent with designations made under 36 CFR Part 212, Subpart
Page 3 of 17

B, unless specifically provided otherwise in the operating plan. Over-snow vehicle use shall be consistent with
designations made under 36 CFR Part 212, Subpart C, unless specifically provided otherwise in the operating
plan.

D. OPERATING PLAN. The holder shall prepare and annually revise by [date] an operating plan. The
operating plan shall be prepared in consultation with the authorized officer or the authorized officer’s designated
representative and shall cover all operations authorized by this permit. The operating plan shall outline steps the
holder will take to protect public health and safety and the environment and shall include sufficient detail and
standards to enable the Forest Service to monitor the holder’s operations for compliance with the terms of this
permit. The operating plan shall be submitted by the holder and approved in writing by the authorized officer or
the authorized officer’s designated representative prior to commencement of operations and shall be attached to
this permit as an appendix. Any operating plan revisions shall be submitted by the holder and approved in writing
by the authorized officer or the authorized officer’s designated representative before they are implemented. The
authorized officer may require an annual meeting with the holder to discuss the terms of the permit or operating
plan, annual use reports, or other concerns either party may have.

E. MONITORING BY THE FOREST SERVICE. The Forest Service shall monitor the holder's operations and
reserves the right to inspect the permit area and authorized facilities and improvements at any time for
compliance with the terms of this permit. The holder shall comply with inspection requirements deemed
appropriate by the authorized officer. The holder’s obligations under this permit are not contingent upon any duty
of the Forest Service to inspect the permit area or authorized facilities or improvements. A failure by the Forest
Service or other governmental officials to inspect is not a justification for noncompliance with any of the terms of
this permit.

D
R

F. CUTTING, DISPOSAL, AND PLANTING OF VEGETATION. This permit does not authorize the cutting of
trees, brush, shrubs, and other plants (“vegetation”). Vegetation may be cut, destroyed, or trimmed only after the
authorized officer or the authorized officer's designated representative has approved in writing and marked or
otherwise identified what may be cut, destroyed, or trimmed. The holder shall notify the authorized officer when
approved cutting, destruction, or trimming of vegetation has been completed. The Forest Service shall determine
in advance of felling the method of disposal of trees felled in the permit area that meet utilization standards.
Disposal may be by sale or without charge per 36 CFR Part 223, as may be most advantageous to the United
States. Debris from felling that does not meet utilization standards shall also be disposed of according to
methods determined by the Forest Service. Planting of vegetation in the permit area must have prior written
approval from the authorized officer.

G. PAID SICK LEAVE REQUIREMENT. Executive Order 13706, Establishing Paid Sick Leave for Federal
Contractors, and its implementing regulations, including the federal contractor paid sick leave clause at 29 CFR
Part 13, Appendix A, are incorporated by reference into this authorization as if fully set forth in this authorization.

IV. RIGHTS AND LIABILITIES

Page 4 of 17

A. LEGAL EFFECT OF THE PERMIT. This permit, which is revocable and terminable, is not a contract or a
lease, but rather a federal license. The benefits and requirements conferred by this authorization are reviewable
solely under the procedures set forth in 36 CFR Part 214 and 5 U.S.C. 704. This permit does not constitute a
contract for purposes of the Contract Disputes Act, 41 U.S.C. 601. The permit is not real property, does not
convey any interest in real property, and may not be used as collateral for a loan.
B. VALID EXISTING RIGHTS. This permit is subject to all valid existing rights. Valid existing rights include
those derived under mining and mineral leasing laws of the United States. The United States is not liable to the
holder for the exercise of any such right.
C. ABSENCE OF THIRD-PARTY BENEFICIARY RIGHTS. The parties to this permit do not intend to confer
any rights on any third party as a beneficiary under this permit.

D. NO WARRANTY OF ACCESS, SITE SUITABILITY, OR SERVICES. This permit authorizes the use and
occupancy of National Forest System lands by the holder for the purposes identified in this permit. The Forest
Service does not make any express or implied warranty of access to the permit area, of the suitability of the
permit area for the authorized uses, or for the furnishing of road or trail maintenance, water, fire protection
services, search and rescue services, or any other services by a government agency, utility, association, or
individual.

D
R

E. RISK OF LOSS. The holder assumes all risk of loss to the authorized improvements and all risk of loss of
use and occupancy of the permit area, in whole or in part, due to public health and safety or environmental
hazards. Loss to the authorized improvements and of use and occupancy of the permit area may result from but
is not limited to theft, vandalism, fire and any fire-fighting activities (including prescribed burns), environmental
contamination, avalanches, rising waters, winds, falling limbs or trees, and other forces of nature. If any
authorized improvements are destroyed or substantially damaged, the authorized officer shall conduct an analysis
to determine whether the improvements can be safely occupied in the future and whether rebuilding should be
allowed. If rebuilding is not allowed, this permit shall terminate. If the authorized officer determines that the
permit area cannot be safely occupied due to a public health or safety or environmental hazard, this permit shall
terminate. Termination under this clause shall not give rise to any claim for damages, including lost profits and
the value of the improvements, by the holder against the Forest Service.
F. DAMAGE TO UNITED STATES PROPERTY. The holder has an affirmative duty to protect from damage the
land, property, and other interests of the United States that are associated with the use and occupancy authorized
by this permit. Damage includes but is not limited to destruction of or damage to National Forest System lands,
fire suppression costs, and destruction of or damage to federally owned improvements.
1. The holder shall be liable for all injury, loss, or damage, including fire suppression costs, prevention and
control of the spread of invasive species, and the costs of rehabilitation or restoration of natural resources,
resulting from the holder’s use and occupancy of the permit area. Compensation shall include but not be limited
to the value of resources damaged or destroyed, the costs of restoration, cleanup, or other mitigation, fire
suppression or other types of abatement costs, and all administrative, legal (including attorney's fees), and other
costs. Such costs may be deducted from a performance bond required under clause IV.J.
2. The holder shall be liable for damage to all roads and trails of the United States caused by use of the holder
or the holder's heirs, assignees, agents, employees, or contractors to the same extent as provided under clause
IV.F.1, except that liability shall not include reasonable and ordinary wear and tear.
G. HEALTH AND SAFETY. The holder shall take all measures necessary to protect the health and safety of all
persons affected by the use and occupancy authorized by this permit. The holder shall promptly abate as
completely as possible and in compliance with all applicable laws and regulations any physical or mechanical
procedure, activity, event, or condition existing or occurring in connection with the authorized use and occupancy
during the term of this permit that causes or threatens to cause a hazard to the health or safety of the public or the
Page 5 of 17

holder’s employees, agents, or contractors. The holder shall as soon as practicable notify the authorized officer
of all serious accidents that occur in connection with these procedures, activities, events, or conditions. The
Forest Service has no duty under the terms of this permit to inspect the permit area or operations of the holder for
hazardous conditions or compliance with health and safety standards.
H. ENVIRONMENTAL PROTECTION
1. Compliance with Environmental Laws. The holder shall in connection with the use and occupancy authorized
by this permit comply with all applicable federal, state, and local environmental laws and regulations, including but
not limited to those established pursuant to the Comprehensive Environmental Response, Compensation, and
Liability Act (CERCLA), as amended, 42 U.S.C. 9601 et seq., the Resource Conservation and Recovery Act, as
amended, 42 U.S.C. 6901 et seq., the Federal Water Pollution Control Act, as amended, 33 U.S.C. 1251 et seq.,
the Oil Pollution Act, as amended, 33 U.S.C. 2701 et seq., the Clean Air Act, as amended, 42 U.S.C. 7401 et
seq., the Toxic Substances Control Act, as amended, 15 U.S.C. 2601 et seq., the Federal Insecticide, Fungicide,
and Rodenticide Act, as amended, 7 U.S.C. 136 et seq., and the Safe Drinking Water Act, as amended, 42 U.S.C.
300f et seq.

2. Definition of Hazardous Material. For purposes of clause IV.H and section V, "hazardous material" shall
mean (a) any hazardous substance under section 101(14) of 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.
3. Oil Discharges and Release of Hazardous Materials. The holder shall immediately notify all appropriate
response authorities, including the National Response Center and the authorized officer or the authorized officer’s
designated representative, of any oil discharge or of the release of a hazardous material in the permit area in an
amount greater than or equal to its reportable quantity, in accordance with 33 CFR Part 153 and 40 CFR Part
302. For the purposes of this requirement, “oil” is defined by section 311(a)(1) of the Clean Water Act, 33 U.S.C.
1321(a)(1). The holder shall immediately notify the authorized officer or the authorized officer’s designated
representative of any release or threatened release of any hazardous material in or near the permit area which
may be harmful to public health or welfare or which may adversely affect natural resources on federal lands.

D
R

4. Remediation of Release of Hazardous Materials. The holder shall remediate any release, threat of
release, or discharge of hazardous materials that occurs in connection with the holder’s activities in the
permit area, including activities conducted by the holder's agents, employees, or contractors and
regardless of whether those activities are authorized under this permit. The holder shall perform
remediation in accordance with applicable law immediately upon discovery of the release, threat of
release, or discharge of hazardous materials. The holder shall perform the remediation to the satisfaction
of the authorized officer and at no expense to the United States. Upon revocation or termination of this
permit, the holder shall deliver the site to the Forest Service in compliance with all applicable laws and
regulations and free and clear of contamination.
I. INDEMNIFICATION OF THE UNITED STATES. The holder shall indemnify, defend, and hold harmless the
United States for any costs, damages, claims, liabilities, and judgments arising from past, present, and future acts
or omissions of the holder in connection with the use or occupancy authorized by this permit. This indemnification
provision includes but is not limited to acts and omissions of the holder or the holder's heirs, assignees, agents,
employees, or contractors in connection with the use and occupancy authorized by this permit which result in
(1) violations of any laws and regulations which are now or which may in the future become applicable;
(2) judgments, claims, demands, penalties, or fees assessed against the United States; (3) costs, expenses, and
damages incurred by the United States; or (4) the release or threatened release of any solid waste, hazardous
waste, hazardous materials, pollutant, contaminant, oil in any form, or petroleum product into the
environment. The authorized officer may prescribe terms that allow the holder to replace, repair, restore, or
otherwise undertake necessary curative actions to mitigate damages in combination with or as an alternative to
monetary indemnification.
J. BONDING. The authorized officer may require the holder to furnish a surety bond or other security for any of
the obligations imposed by the terms of this permit or any applicable law, regulation, or order.
Page 6 of 17

1. As a further guarantee of compliance with the terms of this permit, the holder shall deliver and maintain a
surety bond or other acceptable security, such as cash deposited and maintained in a federal depository or
negotiable securities of the United States, in the amount of #AMOUNT# for [specify obligations covered, e.g., to
secure the holder’s obligation to restore the permit area after construction or upon revocation or termination of the
permit without issuance of a new permit]. The authorized officer may periodically evaluate the adequacy of the
bond or other security and increase or decrease the amount as appropriate. If the bond or other security
becomes unsatisfactory to the authorized officer, the holder shall within 30 days of demand furnish a new bond or
other security issued by a surety that is solvent and satisfactory to the authorized officer. If the holder fails to
meet any of the requirements secured under this clause, money deposited pursuant to this clause shall be
retained by the United States to the extent necessary to satisfy the obligations secured under this clause, without
prejudice to any other rights and remedies of the United States.

2. The bond shall be released or other security returned 30 days after (a) the authorized officer certifies that the
obligations covered by the bond or other security are met and (b) the holder establishes to the satisfaction of the
authorized officer that all claims for labor and material for the secured obligations have been paid or released.
3. The holder may be required to obtain additional bonding or security prior to undertaking additional
construction or alteration not covered by the bond or other security or when the authorized improvements are to
be removed and the permit area restored.

K. STRICT LIABILITY. The holder shall be strictly liable (liable without proof of negligence) to the United States
up to the limit specified in 36 CFR 251.56(d)(2), as amended, per occurrence for any injury, loss, or damage
arising in tort under this permit. Liability in tort for injury, loss, or damage to the United States exceeding the
prescribed amount of strict liability in tort shall be determined under the law of negligence.

D
R

L. INSURANCE. The holder shall furnish proof of insurance, such as a certificate of insurance, to the authorized
officer prior to issuance of this permit and each year thereafter that this permit is in effect. The Forest Service
reserves the right to review the insurance policy and require any changes needed to ensure adequate coverage
of the United States in connection with the authorized use and occupancy. The holder shall send an
authenticated copy of any insurance policy obtained pursuant to this clause to the authorized officer immediately
upon issuance of the policy. Any insurance policy obtained by the holder pursuant to this clause shall include the
United States as an additional insured in an endorsement to the policy, and the additional insured provision shall
provide for insurance coverage for the United States as required under this clause and to the extent of the full
limits of insurance available to the holder. The holder shall give 30 days prior written notice to the authorized
officer of cancellation of or any modification to the insurance policy. The certificate of insurance, the
authenticated copy of the insurance policy, and written notice of cancellation or modification of an insurance
policy should be sent to __________. Minimum amounts of coverage and other insurance requirements are
subject to change at the sole discretion of the authorized officer on the anniversary date of this permit.
1. The holder shall have in force liability insurance covering losses [, including those arising from strict liability,]
associated with the use or occupancy authorized by this permit arising from personal injury or death and thirdparty property damage in the minimum amount of $__________ as a combined single limit per occurrence.
Page 7 of 17

2. Depending on the holder's operations, the Forest Service may require the holder to demonstrate the
availability of funds to address any release or threatened release of hazardous materials that may occur in
connection with the holder's use or occupancy. Any requirements imposed would be established on a case-bycase basis by the authorized officer based on the degree of environmental risk from the holder's operations. The
storage and use of normal maintenance supplies in nominal amounts generally would not trigger financial
assurance requirements.

D
R

F. HEALTH AND SAFETY. The holder shall take all measures necessary to protect the health and safety of all
persons affected by the use and occupancy authorized by this permit. The holder shall promptly abate as
completely as possible and in compliance with all applicable laws and regulations any physical or mechanical
procedure, activity, event, or condition existing or occurring in connection with the authorized use and occupancy
during the term of this permit that causes or threatens to cause a hazard to the health or safety of the public or the
holder’s employees, agents, or contractors. The holder shall as soon as practicable notify the authorized officer
of all serious accidents that occur in connection with these procedures, activities, events, or conditions. The
Forest Service has no duty under the terms of this permit to inspect the permit area or operations of the holder for
hazardous conditions or compliance with health and safety standards.
G. ENVIRONMENTAL PROTECTION

1. Compliance with Environmental Laws. The holder shall in connection with the use and occupancy authorized
by this permit comply with all applicable federal, state, and local environmental laws and regulations, including but
not limited to those established pursuant to the Comprehensive Environmental Response, Compensation, and
Liability Act (CERCLA), as amended, 42 U.S.C. 9601 et seq., the Resource Conservation and Recovery Act, as
amended, 42 U.S.C. 6901 et seq., the Federal Water Pollution Control Act, as amended, 33 U.S.C. 1251 et seq.,
the Oil Pollution Act, as amended, 33 U.S.C. 2701 et seq., the Clean Air Act, as amended, 42 U.S.C. 7401 et
seq., the Toxic Substances Control Act, as amended, 15 U.S.C. 2601 et seq., the Federal Insecticide, Fungicide,
and Rodenticide Act, as amended, 7 U.S.C. 136 et seq., and the Safe Drinking Water Act, as amended, 42 U.S.C.
300f et seq.
2. Definition of Hazardous Material. For purposes of clause IV.G and section V, "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.
Page 8 of 17

3. Oil Discharges and Release of Hazardous Materials. The holder shall immediately notify all appropriate
response authorities, including the National Response Center and the authorized officer or the authorized officer’s
designated representative, of any oil discharge or of the release of a hazardous material in the permit area in an
amount greater than or equal to its reportable quantity, in accordance with 33 CFR Part 153 and 40 CFR Part
302. For the purposes of this requirement, “oil” is as defined by section 311(a)(1) of the Clean Water Act, 33
U.S.C. 1321(a)(1). The holder shall immediately notify the authorized officer or the authorized officer’s
designated representative of any release or threatened release of any hazardous material in or near the permit
area which may be harmful to public health or welfare or which may adversely affect natural resources on federal
lands.
4. Remediation of Release of Hazardous Materials. The holder shall remediate any release, threat of release, or
discharge of hazardous materials that occurs in connection with the holder’s activities in the permit area, including
activities conducted by the holder's agents, employees, or contractors and regardless of whether those activities
are authorized under this permit. The holder shall perform remediation in accordance with applicable law
immediately upon discovery of the release, threat of release, or discharge of hazardous materials. The holder
shall perform the remediation to the satisfaction of the authorized officer and at no expense to the Forest
Service. Upon revocation or termination of this permit, the holder shall deliver the site to the Forest Service in
compliance with all applicable laws and regulations and free and clear of contamination.

H. LIABILITY FOR INJURY. As an agency of the United States, the holder is limited by federal law as to the
assumption of liability for its acts or omissions. The holder agrees, within its legal limitations and limitations of
appropriations, to be responsible for all damages arising from injury to persons or property associated with the
use and occupancy authorized by this permit. The holder further agrees, to the extent legally permissible, to use
its appropriations and resources as required to pay any claims and to repair damage to the federal lands covered
by this permit. The Forest Service is exempt from any burdens, other than administrative costs, which may arise
in connection with the use and occupancy authorized by this permit.
V. RESOURCE PROTECTION

D
R

A. WATER POLLUTION. No waste or by-product shall be discharged into water in connection with the use and
occupancy authorized by this permit except in full compliance with all applicable federal, state, and local
environmental and other laws. Storage facilities for materials capable of causing water pollution, if accidentally
discharged, shall be located so as to prevent any spillage into waters or channels leading into water except in full
compliance with all applicable federal, state, and local environmental and other laws.
B. SCENIC VALUES. The holder shall protect the scenic values of the permit area and the adjacent land to the
greatest extent possible during construction, operation, and maintenance of the authorized improvements.
C. VANDALISM. The holder shall take reasonable measures to prevent and discourage vandalism and
disorderly conduct and when necessary, shall contact the appropriate law enforcement officer.
D. PESTICIDE USE
1. Authorized Officer Concurrence. Pesticides may not be used outside of buildings in the permit area to control
pests, including undesirable woody and herbaceous vegetation (including aquatic plants), insects, birds, rodents,
or fish without prior written concurrence of the authorized officer. Only those products registered or otherwise
authorized by the U.S. Environmental Protection Agency and appropriate State authority for the specific purpose
planned shall be authorized for use within areas on National Forest System lands.
2. Pesticide-Use Proposal. Requests for concurrence of any planned uses of pesticides shall be provided in
advance using the Pesticide-Use Proposal (form FS-2100-2). Annually the holder shall, on the due date
established by the authorized officer, submit requests for any new, or continued, pesticide usage. The PesticideUse Proposal shall cover a 12-month period of planned use. The Pesticide-Use Proposal shall be submitted at
least 60 days in advance of pesticide application. Information essential for review shall be provided in the form
Page 9 of 17

specified. Exceptions to this schedule may be allowed, subject to emergency request and approval, only when
unexpected outbreaks of pests require control measures which were not anticipated at the time a Pesticide-Use
Proposal was submitted.
3. Safety Plan. Before applying pesticides in the permit area, the holder shall submit to the authorized officer a
safety plan that includes, at a minimum, a precise statement of the treatment objectives; a description of the
equipment, materials, and supplies to be used, including pesticide formulation, quantities, and application
methods; a description of the lines of responsibility for project planning, project monitoring, and after-action
review; a description of any necessary interagency coordination; a copy of the current Pesticide-Use Proposal for
the permit; a description of the process by which treatment effectiveness will be determined; and a spill plan,
communications plan, security plan, and when required by applicable local requirements, a provision for prior
notification to sensitive individuals.
4. Reporting. By September 30th annually, the holder shall submit to the authorized officer a written report of
each pesticide application project completed during the previous 12-month period. The report shall contain
information pertaining to the pesticide application projects as requested by the authorized officer.

5. Labeling, Laws, and Regulations. Label instructions and all applicable laws and regulations shall be strictly
followed in the application of pesticides and disposal of excess materials and containers. No pesticide waste,
excess materials, or containers shall be disposed of in any area administered by the Forest Service.

E. ARCHAEOLOGICAL AND PALEONTOLOGICAL DISCOVERIES. The holder shall immediately notify the
authorized officer of any antiquities or other objects of historic or scientific interest, including but not limited to
historic or prehistoric ruins, fossils, or artifacts discovered in connection with the use and occupancy authorized
by this lease. The holder shall leave these discoveries intact and in place until otherwise directed by the
authorized officer.

D
R

F. NATIVE AMERICAN GRAVES PROTECTION AND REPATRIATION ACT (NAGPRA). In accordance with
25 U.S.C. 3002(d) and 43 CFR 10.4, if the holder inadvertently discovers human remains, funerary objects,
sacred objects, or objects of cultural patrimony on National Forest System lands, the holder shall immediately
cease work in the area of the discovery and shall leave the discoveries intact and in place. The holder shall follow
the applicable NAGPRA protocols for the undertaking provided in the NAGPRA plan of action or the NAGPRA
comprehensive agreement; if there are no such agreed-upon protocols, the holder shall as soon as practicable
notify the authorized officer of the discovery and shall follow up with written confirmation of the discovery. The
activity that resulted in the inadvertent discovery may not resume until 30 days after the authorized officer certifies
receipt of the written confirmation, if resumption of the activity is otherwise lawful, or at any time if a NAGPRA
plan of action has been executed by the Forest Service following tribal consultation and any preconditions have
been met.
G. PROTECTION OF THREATENED AND ENDANGERED SPECIES, SENSITIVE SPECIES, AND SPECIES
OF CONSERVATION CONCERN AND THEIR HABITAT
1. Threatened and Endangered Species and Their Habitat. The location of sites within the permit area needing
special measures for protection of plants or animals listed as threatened or endangered under the Endangered
Species Act (ESA) of 1973, 16 U.S.C. 1531 et seq., as amended, or within designated critical habitat shall be
shown on a map in an appendix to this permit and may be shown on the ground. The holder shall take any
protective and mitigation measures specified by the authorized officer as necessary and appropriate to avoid or
reduce effects on listed species or designated critical habitat affected by the authorized use and occupancy.
Discovery by the holder or the Forest Service of other sites within the permit area containing threatened or
endangered species or designated critical habitat not shown on the map in the appendix shall be promptly
reported to the other party and shall be added to the map.
2. Sensitive Species and Species of Conservation Concern and Their Habitat. The location of sites within the
permit area needing special measures for protection of plants or animals designated by the Regional Forester as
sensitive species or as species of conservation concern pursuant to FSM 2670 shall be shown on a map in an
appendix to this permit and may be shown on the ground. The holder shall take any protective and mitigation
measures specified by the authorized officer as necessary and appropriate to avoid or reduce effects on sensitive
species or species of conservation concern or their habitat affected by the authorized use and
Page 10 of 17

occupancy. Discovery by the holder or the Forest Service of other sites within the permit area containing
sensitive species or species of conservation concern or their habitat not shown on the map in the appendix shall
be promptly reported to the other party and shall be added to the map.
H. CONSENT TO STORE HAZARDOUS MATERIALS. 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 or
release prevention and control plan. Such terms shall be proposed by the holder and are subject to approval by
the authorized officer.

1. If the holder receives consent to store hazardous material, the holder shall identify to the Forest Service any
hazardous material to be stored at the site. This identifying information shall be consistent with column (1) of the
table of hazardous materials and special provisions enumerated at 49 CFR 172.101 whenever the hazardous
material appears in that table. For hazard communication purposes, the holder shall maintain Material Safety
Data Sheets for any stored hazardous chemicals, consistent with 29 CFR 1910.1200(c) and (g). In addition, all
hazardous materials stored by the holder shall be used, labeled, stored, transported, and disposed of in
accordance with all applicable federal, state, and local laws and regulations. Any hazardous material
transportation and disposal manifests shall clearly identify the holder as the generator of the hazardous waste.
2. If hazardous materials are used or stored at the site, the authorized officer may require the holder to deliver
and maintain a surety bond in accordance with clause IV.J.

D
R

3. The holder shall not release any hazardous materials onto land or into rivers, streams, impoundments, or into
natural or artificial channels leading thereto. All prudent and safe attempts must be made to contain any release
of these materials. The authorized officer may specify conditions that must be met, including conditions more
stringent than those in applicable federal, state, and local laws and regulations, to prevent releases and protect
natural resources.
4. If the holder uses or stores hazardous materials at the site, upon revocation or termination of this
permit the holder shall provide the Forest Service with a report certified by a professional or professionals
acceptable to the Forest Service that the permit area is uncontaminated by the presence of hazardous
materials and that there has not been a release or discharge of hazardous materials upon the permit
area, into surface water at or near the permit area, or into groundwater below the permit area during the
term of the permit. If a release or discharge has occurred, the professional or professionals shall
document and certify that the release or discharge has been fully remediated and that the permit area is
in compliance with all applicable federal, state, and local laws and regulations.
I. FEDERAL SURVEY MONUMENTS, CORNERS, and BOUNDARY MARKERS. The holder shall
protect in place all federal survey monuments, corners, and boundary markers in the permit area. If any
federal survey monuments, corners, or boundary markers in the permit area are destroyed or modified,
the holder shall ensure that they are reestablished or corrected in accordance with (1) the Manual of
Instructions for the Survey of the Public Land of the United States; (2) the applicable county surveyor’s
specifications; and (3) the specifications of the Forest Service, as applicable. The holder shall ensure
that any official survey records that were affected due to the destruction or modification of any federal
survey monuments, corners, or boundary markers are amended in accordance with applicable law.
Nothing in this clause shall relieve the holder of liability for the willful destruction or modification of any
federal survey monuments, corners, or boundary markers as provided in 18 U.S.C. 1858.
VI. LAND USE FEE AND DEBT COLLECTION
Page 11 of 17

A. LAND USE FEE. The holder is exempt from a land use fee pursuant to 36 CFR 251.57 and Forest Service
Handbook 2709.11, Chapter 30.

A. LAND USE FEE. The holder’s land use fee has been waived pursuant to 36 CFR 251.57 and Forest Service
Handbook 2709.11, Chapter 30. The authorized officer reserves the right to review the land use fee waiver
determination periodically and to charge all or part of the land use fee if the waiver is no longer appropriate.

A. LAND USE FEE. [From FSH 2709.11, Chapter 50, insert clause A-16 for organizational camps or clauses
A-1 and A-2 for uses subject to GRFS.]

A. LAND USE FEE. Per 42 U.S.C. 15925, the holder shall pay in advance an annual land use fee as
determined in accordance with the Per Acre Rent Schedule established by 43 CFR 2806.20. The initial annual
land use fee shall be prorated if less than 6 months in the calendar year remain on the date this permit is
issued. Otherwise, the holder shall pay the entire initial annual land use fee.

D
R

A. LAND USE FEE. The holder shall pay in advance an annual land use fee of $_______. The annual land
use fee will be adjusted annually using the [applicable indexing factor].

A. LAND USE FEE. The holder shall pay in advance an annual land use fee in accordance with the fee
schedule for communications uses in Forest Service Handbook 2709.11, Chapter 90. The annual land use fee
shall be adjusted annually using the Consumer Price Index-Urban (CPI-U).
B. MODIFICATION OF THE LAND USE FEE. The land use fee may be revised whenever necessary to reflect
the market value of the authorized use or occupancy or when the fee system used to calculate the land use fee is
modified or replaced.
C. LAND USE FEE PAYMENTS
1. Crediting of Payments. Payments shall be credited on the date received by the deposit facility, except that if a
payment is received on a non-workday, the payment shall not be credited until the next workday.
2. Disputed Land Use Fees. Land use fees are due and payable by the due date. Disputed land use fees, other
than land use fees recalculated pursuant to an audit, must be paid in full. Adjustments will be made if dictated by
an administrative appeal decision, a court decision, or settlement terms.
3. Late Payments
Page 12 of 17

(a) Interest. Pursuant to 31 U.S.C. 3717 et seq., interest shall be charged on any land use fee not paid within 30
days from the date it became due. The rate of interest assessed shall be the higher of the Prompt Payment Act
rate or the rate of the current value of funds to the United States Treasury (i.e., the Treasury tax and loan account
rate), as prescribed and published annually or quarterly by the Secretary of the Treasury in the Federal Register
and the Treasury Fiscal Requirements Manual Bulletins. Interest on the principal shall accrue from the date the
land use fee is due.
(b) Administrative Costs. If the account becomes delinquent, administrative costs to cover processing and
handling the delinquency shall be assessed.
(c) Penalties. Pursuant to 31 U.S.C. 3717(e)(2), a penalty of 6% per year shall be assessed on the total amount
of any debt, including interest and administrative costs, that is more than 90 days delinquent. The penalty shall
accrue from the same date on which interest charges begin to accrue.
(d) Termination for Nonpayment. This permit shall terminate if the holder fails to pay any land use fee, interest,
or any other charges within 90 calendar days of the due date. The holder shall remain responsible for the
delinquent charges.

4. Administrative Offset and Credit Reporting. Delinquent land use fees and other charges associated with this
permit shall be subject to all rights and remedies afforded the United States pursuant to 31 U.S.C. 3711 et seq.
and its implementing regulations. Delinquencies are subject to any or all of the following:

(a) Administrative offset of payments due the holder from the Forest Service.

(b) If in excess of 120 days, referral to the United States Department of the Treasury for appropriate collection
action as provided by 31 U.S.C. 3711(g)(1) and its implementing regulations.
(c) Offset by the Secretary of the Treasury of any amount due the holder, as provided by 31 U.S.C. 3720A et seq.
(d) Disclosure to consumer or commercial credit reporting agencies.

D
R

5. Consolidated Land Use Fee Payment. Payment of annual land use fees for #AMOUNT# years shall be
consolidated. The first consolidated land use fee payment shall be made on [date first full payment is due], when
the first full annual land use fee payment is due, and thereafter every #AMOUNT# years from [date first full
payment is due], until this permit expires.
VII. REVOCATION, SUSPENSION, AND TERMINATION

A. REVOCATION AND SUSPENSION
1. The authorized officer may not revoke or suspend this permit without the concurrence of the holder.
Page 13 of 17

A. REVOCATION AND SUSPENSION
1. The authorized officer may revoke or suspend this permit in whole or in part:
(a) For noncompliance with federal, state, or local law;
(b) For noncompliance with the terms of this permit;
(c) For abandonment or other failure of the holder to exercise the privileges granted; or

(d) At the discretion of the authorized officer, for specific and compelling reasons in the public interest.

2. The authorized officer may revoke this permit at the request of the holder. Revocation at the request of the
holder must be agreed to in writing by the authorized officer. As a condition of revocation of this permit at the
request of the holder, the authorized officer has discretion to impose any terms deemed appropriate as provided
for in this permit.
3. Prior to revocation or suspension, other than revocation at the request of the holder under clause VII.A.2 and
immediate suspension under clause VII.B, the authorized officer shall give the holder written notice of the grounds
for revocation or suspension and a reasonable period, typically not to exceed 90 days, to cure any
noncompliance.

D
R

B. IMMEDIATE SUSPENSION. The authorized officer may immediately suspend this permit in whole or in part
when necessary to protect public health or safety or the environment. The suspension decision shall be in writing.
The holder may request an on-site review with the authorized officer’s superior of the adverse conditions
prompting the suspension. The authorized officer’s superior shall grant this request within 48 hours. Following
the on-site review, the authorized officer’s superior shall promptly affirm, modify, or cancel the suspension.
C. APPEALS AND REMEDIES. Written decisions by the authorized officer relating to administration of this
permit are subject to administrative appeal pursuant to 36 CFR Part 214, as amended. Revocation or suspension
of this permit shall not give rise to any claim for damages by the holder against the Forest Service.
D. TERMINATION. This permit shall terminate when by its terms a fixed or agreed upon condition, event, or
time occurs without any action by the authorized officer. Examples include but are not limited to expiration of the
permit by its terms on a specified date and, in the case of a permit issued to a business entity, termination upon
change of control of the business entity and issuance of a new permit to another party for the use and occupancy
authorized by this permit. Termination of this permit shall not require notice, a decision document, or any
environmental analysis or other documentation. Termination of this permit is not subject to administrative appeal
and shall not give rise to any claim for damages by the holder against the Forest Service.

E. RIGHTS AND RESPONSIBILITIES UPON REVOCATION OR TERMINATION WITHOUT ISSUANCE OF A
NEW PERMIT. Upon revocation or termination of this permit without issuance of a new permit, the holder shall
remove all structures and improvements, except those owned by the United States, within a reasonable period
prescribed by the authorized officer and shall restore the site to the satisfaction of the authorized officer. If the
holder fails to remove all structures and improvements within the prescribed period, they shall become the
property of the United States and may be sold, destroyed, or otherwise disposed of without any liability to the
Page 14 of 17

United States. However, the holder shall remain liable for all costs associated with their removal, including costs
of sale and impoundment, cleanup, and restoration of the site.

E. RIGHTS AND RESPONSIBILITIES UPON REVOCATION OR TERMINATION WITHOUT ISSUANCE OF A
NEW PERMIT. Upon revocation or termination of this permit without issuance of a new permit, the holder shall
remove within a reasonable period prescribed by the authorized officer all structures and improvements installed
by the holder in the permit area and shall restore the site to the satisfaction of the authorized officer.
F. CONTINUATION OF OBLIGATIONS AND LIABILITIES BEYOND TERMINATION OR REVOCATION.
Notwithstanding the termination or revocation of this permit, its terms shall remain in effect and shall be binding
on the holder and the holder’s personal representative, successors, and assignees until all the holder’s
obligations and liabilities accruing before or as a result of termination or revocation of this permit have been
satisfied.

D
R

G. TERMINATION FOR THE DEVELOPMENT OF HYDROELECTRIC POWER OR RECLAMATION
PURPOSES. Any lands covered by this permit which have been withdrawn for hydroelectric power under the act
of March 3, 1879, or the act of June 25, 1910, or are covered by an application or license governed by the
Federal Power Act of June 10, 1920, are subject at any time to use for the development of hydroelectric power.
Any lands covered by this permit which have been withdrawn under the Reclamation Act of June 17, 1902, are
subject at any time to use for reclamation purposes. This permit is issued with the specific understanding that
(1) the use and occupancy authorized by this permit shall not interfere with such development of hydroelectric
power or reclamation and that (2) this permit shall terminate after 90 days written notice when, in the judgment of
the Federal Power Commission, the lands in question are needed for the development of hydroelectric power or,
in the judgment of the Bureau of Reclamation, the lands in question are needed for reclamation purposes. The
holder shall have 90 days to remove the authorized improvements. [Termination under this clause shall not give
rise to any claim by the holder against the Federal Power Commission, the Bureau of Reclamation, the Forest
Service, or hydroelectric power licensees for damages, including lost profits and damage to improvements, due to
such development of hydroelectric power or reclamation.]
VIII. MISCELLANEOUS PROVISIONS

A. MEMBERS OF CONGRESS. No member of or delegate to Congress or resident commissioner shall benefit
from this permit either directly or indirectly, except to the extent the authorized use provides a general benefit to a
corporation.
B. CURRENT ADDRESSES. The holder and the Forest Service shall keep each other informed of current
mailing addresses, including those necessary for billing and payment of land use fees.
C. SUPERSEDED AUTHORIZATION. This permit supersedes a special use authorization designated
#PREV_REISSUE_HOLDER#, #PREV_AUTH_ID#, dated #PREV_REIS_ISSUE_DATE#.
D. MERGER CLAUSE. This permit, and any appendices incorporated into this permit by reference, constitute
the complete understanding of the parties to this permit as to the rights, duties, and obligations of each party as of
the date of issuance of this permit. If there are any inconsistencies between any of the preceding clauses and any
subsequent clauses or any appendices to this permit, the preceding clauses shall govern.
THIS PERMIT IS ACCEPTED SUBJECT TO ALL ITS TERMS.
Page 15 of 17

BEFORE THIS PERMIT IS ISSUED TO AN ENTITY, DOCUMENTATION MUST BE PROVIDED TO THE
AUTHORIZED OFFICER OF THE AUTHORITY OF THE SIGNATORY FOR THE ENTITY TO BIND IT TO THE
TERMS OF THIS PERMIT.
ACCEPTED:
___________________________________________________________________________________
[NAME AND TITLE OF PERSON SIGNING ON BEHALF OF HOLDER,
DATE
IF HOLDER IS AN ENTITY]
#HOLDER_NAME#
APPROVED:

___________________________________________________________________________________
#AUTHORIZED OFFICER NAME#
DATE
#TITLE#
_____________ National Forest
USDA Forest Service

D
R

Page 16 of 17

PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995, a Federal agency may not conduct or sponsor, and a person is not required to respond to,
an information collection request unless it displays a valid Office of Management and Budget (OMB) control number. The valid OMB control
number for this information collection request is 0596-0082. Response to this information collection request is required to obtain or retain
benefits, specifically, a special use authorization. The authority for this information collection request is #AUTHORITY_NAME#. The time
required to complete this information collection request is estimated to average 1 hour per response, including the time for reviewing
instructions, searching existing data sources, collecting and maintaining the data needed, and completing and reviewing the information
collection request. Send comments regarding this burden estimate or any other aspect of this information collection request, including
suggestions for reducing the burden, to Forest Service Information Collections Officer, SM.FS.InfoCollect@usda.gov, with OMB control
number 0596-0082 in the subject line.
PRIVACY ACT STATEMENT
Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act statement serves to inform you of the following concerning the collection of the information
on this form.
Purpose: The Privacy Act of 1974 requires that the Director of Recreation, Heritage, and Volunteer Resources staff and the Director of
Lands, Minerals, and Geology Management staff provide the following statements to individuals from whom they request information.
Authority: Collection of this information solicited on this form is authorized by #AUTHORITY_NAME#.

Routine Uses: The information collected will be used by Forest Service officials to ensure that your use of National Forest System lands is
administered in accordance with applicable statutes, regulations, and directives. The information collected from you is retained in the Special
Uses Data System (SUDS) and is retrieved by the Forest Service create reports for the Agency’s Special Uses Program, generate bills for
collection of land use fees for your authorization, monitor compliance with your special use authorization, and other matters pertaining to
administration of your special use authorization. SUDS is a component of the Forest Service’s Natural Resources Manager database (NRM).
A complete list of the routine uses of NRM can be found in the system of records notice associated with this form, FS-24.

Disclosure: The submission of this information is required to obtain or retain benefits, specifically, a special use authorization.
NONDISCRIMINATION STATEMENT

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, 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.

D
R

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 State or local Agency that administers the program or contact USDA through the
Telecommunications Relay Service at 711 (voice and TTY). 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 the information
requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit the 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. 202509410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.
USDA is an equal opportunity provider, employer, and lender.

Page 17 of 17

File Type	application/pdf
File Title	FS-2700-4 Special Use Permit
File Modified	2025-06-23
File Created	2024-08-20