FS-2700-3b Special Use Application & Permit for Noncommercial Group

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Authorization ID: Contact ID: Expiration Date:	FS-2700-3b (09/2020) OMB No. 0596-0082
U.S. DEPARTMENT OF AGRICULTURE FOREST SERVICE SPECIAL USE PERMIT FOR NONCOMMERCIAL GROUP USE Authority: Organic Act of 1897,16 U.S.C. 551 PART I - APPLICATION
____________________________________________________________________________________________ 1. APPLICANT INFORMATION: Name of Group or Event: Address of Group or Contact: Name of Contact: The contact shall be available to the Forest Service from the date this application is signed until it is accepted, rejected, or denied. Day Phone:            Evening Phone:
____________________________________________________________________________________________ 2. DESCRIPTION OF PROPOSED ACTIVITY:
____________________________________________________________________________________________ 3. LOCATION & DESCRIPTION OF NATIONAL FOREST SYSTEM LANDS & FACILITIES APPLICANT WOULD LIKE TO USE:
____________________________________________________________________________________________ 4. ESTIMATED NUMBER OF PARTICIPANTS & SPECTATORS FOR PROPOSED ACTIVITY: Participants:            Spectators:
____________________________________________________________________________________________ 5. STARTING & ENDING DATE & TIME OF PROPOSED ACTIVITY: Start Date: Time:            End Date: Time:
____________________________________________________________________________________________ 6. NAME OF PERSONS WHO WILL SIGN A SPECIAL USE PERMIT ON BEHALF OF THE GROUP (May be same as contact listed in item 1.):
Name: Address: Day Phone: Evening Phone: Signature: _____________________________________ Date:	Name: Address: Day Phone: Evening Phone: Signature: _____________________________________ Date:
APPLICATION NOT VALID UNLESS SIGNED BY CONTACT ____________________________________          Date: Signature of Contact
18 U.S.C. § 1001 makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction. Anyone who knowingly or willfully makes or uses any false writing shall be fined not more than $10,000 or imprisoned not more than five years, or both.

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User Note: Case File: Attach part II "Permit" to part I "Application"

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PART II - PERMIT

Purpose:

Noncommercial group use permits do not grant or deny freedom of assembly or freedom of speech. The rights to freedom of assembly and freedom of speech are guaranteed by the United States Constitution. These rights are fully respected by the Forest Service. When noncommercial group use permits are issued, they regulate time, place, and manner with respect to the exercise of these rights by groups of 75 or more people on National Forest System lands. Noncommercial group use permits authorize the holder to use and occupy the National Forest System lands covered by the permit, subject to rights retained by the United States, including continuing rights of access, a continuing right of physical entry for inspection, monitoring, or for any other purposes consistent with any right or obligation of the United States, and the right to require common use of the land or to authorize use by others in any way that is not inconsistent with the privileges granted by the permit. The use and occupancy authorized by a noncommercial group use permit would not be allowed without the permit. The primary purposes of noncommercial group use permits include protection of National Forest System lands and resources, promotion of public health and safety, and allocation of space among competing uses of National Forest System lands.

1. Use under this permit shall begin on and end on . The permit shall not be extended.

2. ********************************* OR ******************(the holder) is hereby authorized to use, subject to the terms of this permit, National Forest System lands described as Sec. **, T. ** S., R. * E., WILLAMETTE MERIDIAN , as shown in attached Exhibit(s). This permit covers approximately 10 acres or miles.

3. The holder is authorized to conduct the following activities and install the following improvements in the permitted area:

4. The holder shall conduct the authorized activities according to the attached approved plans and specifications, Exhibit(s) . The holder shall not install any improvements not specifically identified and approved in clause 3, in exhibits attached to this permit, or by the authorized officer during the activity authorized by this permit.

5. 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.

6. 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.

7. 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 damages, other than ordinary wear and tear, to National Forest System lands, roads and trails caused by the holder's activities.

8. 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.

9. The holder shall be liable for any injury, loss, or damage, including fire suppression costs and environmental harm or injury to natural resources, that arises in connection with the use and occupancy authorized by this permit.

10. The holder shall indemnify and hold harmless the United States for any injury, loss, or damage, including third-party claims, damage to federal property, fire suppression costs, and environmental harm or injury to natural resources, that arises in connection with the use and occupancy authorized by this permit.

11. The persons who sign this permit are not subject to any individual liability under this permit as a result of that signature. They provide their name solely to allow notice of actions pertaining to the permit to be communicated to the holder and to give the permit legal effect. At least one of the persons who sign this permit shall be available to the Forest Service from the date this permit is issued until the use authorized by this permit has concluded.

12. The holder agrees to permit 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.

13. This permit is subject to all valid existing rights and claims outstanding in third parties.

14. This authorization may be revoked or suspended only in accordance with 36 CFR 251.60(a)(1)(i). 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 days, 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 the restoration of the site.

15. 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.

16. Any decision concerning this permit, including but not limited to suspension or revocation and modification of permit terms and conditions, is not subject to administrative appeal and is immediately subject to judicial review.

17. This permit is accepted subject to the conditions set forth herein, including any conditions in any exhibits attached to and made a part of this permit.

18. The above clauses shall control if they conflict with additional clauses or provisions.

I have read and understand the terms and conditions and agree to abide by them. HOLDER:	U.S. DEPARTMENT OF AGRICULTURE Forest Service Authorization is granted:
By: __________________________________________ (Holder Signature)	By: __________________________________________ (Authorized Officer Signature)
Name: ________________________________________	Name: ________________________________________
Date: ________________________________________	Title: ________________________________________
	Date: ________________________________________

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.

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