FS-2700-25 Temporary Special Use Permit

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

FS-2700-25 (XX/202X)
OMB NO. 0596-0082

U.S. DEPARTMENT OF AGRICULTURE
FOREST SERVICE
TEMPORARY SPECIAL USE PERMIT
(FSH 2709.11, sec. 54.6)
AUTHORITY:
ACT OF MAY 26, 2000, PL 106-206 May 26, 2000

#HOLDER_NAME# of #HOLDER_ADD_LINE_1#, #HOLDER_ADD_LINE_2#,
#HOLDER_ADD_LINE_3#, #HOLDER_CITY#, #HOLDER_STATE# #HOLDER_ZIP#, hereinafter called
the Holder, is hereby authorized to use, subject to the terms and conditions of this permit, National Forest
System land identified within the unit area and described as ,
, as shown on the attached Exhibit(s)
. This authorization covers approximately #USE_ACRES# acres and/or #USE_MILES# miles.

The holder is authorized to conduct the following activities and/ or install the following temporary
improvements on the permitted area:
#PURPOSE#

TERMS AND CONDITIONS

A. Use under this permit shall begin on #Date# and end on #EXPIRATION DATE#. The permit shall not
be extended.
B. The fee for this use is $ Amount. It shall be paid in advance and is not refundable.
C. The holder shall conduct the authorized activities according to the attached approved plans and
specifications, Exhibit(s) .
D. The holder shall not install any improvements not specifically identified and approved above.
E. No soil, trees, or other vegetation may be destroyed or removed from National Forest System lands
without specific prior written permission from the authorized officer.
F. The holder shall comply with all Federal, State, county, and municipal laws, ordinances, and
regulations which are applicable to the area or operations covered by this permit.

G. The holder shall maintain the improvements and premises to standards of repair, orderliness,
neatness, sanitation, and safety acceptable to the authorized officer. The holder shall fully repair and
bear the expense for all damage, other than ordinary wear and tear, to National Forest System lands,
roads and trails caused by the holder's activities.
H. The holder has the responsibility of inspecting the use area and adjoining areas for dangerous trees,
hanging limbs, and other evidence of hazardous conditions which would pose a risk of injury to
individuals. After securing permission from the authorized officer, the holder shall remove such hazards.
I. The holder shall be liable for any damage suffered by the United States resulting from or related to use
of this permit, including damages to National Forest resources and costs of fire suppression.
J. The holder shall hold harmless the United States from any liability from damage to life or property
arising from the holder's occupancy or use of National Forest lands under this permit.
K. The holder agrees to permit the free and unrestricted access to and upon the premises at all times for
all lawful and proper purposes not inconsistent with the intent of the permit or with the reasonable
exercise and enjoyment by the holder of the privileges thereof.
L. This permit is subject to all valid existing rights and claims outstanding in third parties.
M. This permit may be revoked upon breach of any of the conditions herein or at the discretion of the
authorized officer. Upon expiration or revocation of this permit, the holder shall immediately remove all
improvements except those owned by the United States, and shall restore the site within day(s), unless
otherwise agreed upon in writing. If the holder fails to remove the improvements, they shall become the
property of the United States, but that will not relieve the holder of liability for the cost of their removal and
restoration of the site.
N. This permit is a license for the use of federally owned land. It does not grant any interest in real
property. This permit is not transferable. The holder shall not enter into any agreements with third parties
for occupancy of the authorized premises and improvements.
O. Appeal of any provisions of this permit or any requirements thereof shall be subject to the appeal
regulations at 36 CFR 214, or revisions thereof.
P. This permit is accepted subject to the conditions set forth herein, condition(s) and Exhibit(s) attached
to and made a part of this permit.
Q. 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.

I have read and understand the terms and conditions and agree to abide by them.

HOLDER:
BY:___________________________________________________
ADDRESS:_____________________________________________
PHONE:_______________________________________________
DATE:________________________________________________
US DEPARTMENT OF AGRICULTURE
FOREST SERVICE:
BY:___________________________________________________
NAME:________________________________________________
(AUTHORIZED OFFICER)
TITLE:________________________________________________
DATE:_________________________________________________
___________________________________________________________________________________

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
the ACT OF MAY 26, 2000, PL 106-206 May 26, 2000. 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 the ACT OF MAY 26, 2000, PL 106-206 May 26,
2000.
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.
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. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.
USDA is an equal opportunity provider, employer, and lender.