FS-2700-5a-Grand I Term Special Use Permit for Recreation Residences in the

Authorization ID: #AUTH_ID#
Contact ID: #HOLDER_ID#
Expiration Date: #EXPIRATION_DATE#
Use Code: 123

FS-2700-5a Grand Island (XX/202X)
OMB No. 0596-0082

U.S. DEPARTMENT OF AGRICULTURE
FOREST SERVICE
TERM SPECIAL USE PERMIT FOR RECREATION RESIDENCES
IN THE GRAND ISLAND NATIONAL RECREATION AREA
AUTHORITY:
Act of March 4, 1915, 16 U.S.C. 497
Act of May 17, 1990, 16 U.S.C. 460aaa through 460aaa-8

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#HOLDER_NAME#, #HOLDER_ADD_LINE_1#, #HOLDER_ADD_LINE_2#, #HOLDER_ADD_LINE_3#, (the
holder) #HOLDER_CITY#, #HOLDER_STATE# #HOLDER_ZIP# [is/are] authorized to occupy a recreation
residence on National Forest System (NFS) lands for personal, noncommercial recreational use on the
Hiawatha National Forest, subject to the terms of this permit and its appendices. A legal description of the
NFS lands covered by this permit (the permit area) is described as follows:
1. Lot #REC_RES_LOT_NUMBER# of the #REC_RES_TRACT_NAME# tract, a plat of which is on file in the
office of the Forest Supervisor;
or

2. #TOWNSHIP_SECT_RANGE# #FIRST_DIVISION# #FIRST_DIV_NAME_NUMBER#,
SECOND_DIVISION# #SECOND_DIV_NAME_NUMBER#, #THIRD_DIVISION#
#THIRD_DIV_NAME_NUMBER#, as shown on the attached map, which is incorporated as Appendix A. This
and any other appendices are hereby incorporated into this permit.
The following appurtenant private improvements, whether on or off the lot, are authorized in addition to the
recreation residence:

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#PURPOSE#

I. GENERAL TERMS

A. AUTHORITY. This permit is issued pursuant to the Act of March 4, 1915, the Term Permit Act, 16 U.S.C.
497, and the Act of May 17, 1990, 16 U.S.C. 460aaa through 460aaa-8; 36 CFR Part 251, Subpart B, as
amended; Forest Service Manual 1920, 1950, 2340, 2720, and 5410; Forest Service Handbook (FSH)
2709.11, Chapters 10-50; FSH 2709.14, Chapter 20; and FSH 5409.12, Chapter 60.
B. AUTHORIZED OFFICER. The authorized officer for this permit is the Forest Supervisor, a District
Ranger, or the Station, Institute, or Area Director with delegated authority pursuant to Forest Service Manual
2700.
C. AUTHORIZED USE. This permit authorizes only noncommercial recreational use by the holder's
immediate family and the holder's non-paying guests, other than incidental rental that has prior written
approval from the authorized officer pursuant to clause VII.A.

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D. 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.
E. CONTINUATION OF USE AND OCCUPANCY. The use and occupancy authorized by this permit shall
be renewed upon expiration of this permit for another 20-year term, provided that, as determined by the
authorized officer, (1) the holder desires to renew the use and occupancy; (2) the use and occupancy are
consistent with the standards and guidelines in the Hiawatha National Forest Land and Resource
Management Plan and the Grand Island Management Plan; (3) the recreation residence is still being used for
the purposes authorized by this permit; and (4) the holder is in compliance with the purposes of the Act of May
17, 1990, 16 U.S.C. 460aaa through 460aaa-8; all applicable regulations; and all the terms of this permit. The
authorized officer may prescribe new terms when a new permit is issued.

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F. CHANGE IN ADDRESS OR OWNERSHIP OF THE RECREATION RESIDENCE. The holder or the
holder's executor or personal representative shall immediately notify the authorized officer of a change in the
holder's permanent address or a change in the ownership of the recreation residence authorized by this
permit.

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G. 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, 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.
H. COMPLIANCE WITH LAWS, REGULATIONS, AND OTHER LEGAL REQUIREMENTS. In exercising
the 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, regulations, 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.

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I. NON-EXCLUSIVE USE. The use and occupancy authorized by this permit are 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 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.
II. IMPROVEMENTS

A. LIMITATIONS ON USE. This permit authorizes only occupancy of a recreation residence. Nothing in this
permit gives or implies permission to build or maintain any structure or improvement 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. Improvements
requiring specific approval shall include but are not limited to signs, fences, name plates, mailboxes,
newspaper boxes, boathouses, docks, pipelines, antennas, water and sewer facilities, retaining walls,
driveways, parking areas, and storage sheds.
B. DRAWINGS. All drawings and revisions to drawings for development, layout, construction, reconstruction
or alteration of improvements on the authorized lot must be prepared by a licensed engineer, architect, or
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

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authorized officer may require the holder to furnish as-built drawings, maps, or surveys upon completion of the
work.
C. EXPANSION, REMODELING, AND RECONSTRUCTION. The expansion, remodeling, or reconstruction
of the recreation residence authorized by this permit shall be subject to approval of and regulation by the
Forest Service. No expansion, remodeling, or reconstruction of the recreation residence authorized by this
permit may increase its height or may result in an increase of more than 25 percent of the sum of its exterior
dimensions as it existed on May 17, 1990. Any expansion, remodeling, or reconstruction of the recreation
residence authorized by this permit shall be consistent with the general design criteria for improvement of
existing facilities developed for the comprehensive management plan for the Grand Island National Recreation
Area.
III. OPERATIONS

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A. OPERATING PLAN. The holder shall prepare an operating plan and any operating plan revisions in
consultation with the authorized officer or the authorized officer’s designated representative. The operating
plan shall cover all activities 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 activities 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 authorized activities 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 operating plan shall, at a minimum, address requirements for the following:
1. Maintenance of vegetation, tree planting, and removal of dangerous trees and other unsafe conditions.
2. Maintenance of the authorized improvements.

3. Size, placement and description of authorized signs.
4. Removal of garbage.
5. Fire protection.

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6. Identification of the person responsible for implementing the operating plan, if other than the holder, and a
list of the name, address, and telephone numbers of persons to contact in the event of an emergency.
7. Process and logistics for receiving approval from the authorized officer.
The operating plan shall be revised as necessary when changes to the authorized use are approved by the
authorized officer.
B. MINIMUM OCCUPANCY AND PROHIBITION ON USE AS PRIMARY PLACE OF RESIDENCE. The
recreation residence authorized by this permit shall not be used as a full-time residence. Use of the permitted
improvements as a principal place of residence is prohibited and shall be grounds for revocation of this permit.
C. MAINTENANCE OF IMPROVEMENTS. The holder shall maintain the authorized improvements and NFS
lands to standards of repair, orderliness, neatness, sanitation, and safety acceptable to the authorized officer.
D. INSPECTION OF THE PERMIT AREA. The holder is responsible for inspecting the permit area (using
Form FS-2700-6b, Recreation Residence Self-Inspection Report), authorized rights-of-way, and adjoining
areas for dangerous trees, hanging limbs, and other evidence of hazardous conditions that could affect the
authorized improvements or pose a risk to public safety. After obtaining written approval from the authorized
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officer, the holder shall remove these hazards at the holder’s expense.
E. USE OF NFS ROADS AND NFS TRAILS. The holder’s use of NFS roads and NFS 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 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.
F. 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 obligations of the holder 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 defense to noncompliance with any of the
terms of this permit.

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G. 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 agent 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.
IV. RIGHTS AND LIABILITIES

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.

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B. VALID EXISTING RIGHTS. This permit is subject to all valid existing rights. Valid existing rights include
those derived from 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 signatories of 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 NFS lands by the holder for the purposes identified in this permit. The Forest Service will
manage access, public health and safety, and protection of the Grand Island National Recreation Area in the
event of fire or infestation of insects and disease consistent with the comprehensive management plan for the
Grand Island National Recreation Area, as amended. Such management consistent with the comprehensive
management plan for the Grand Island National Recreation Area, as amended, does not constitute an
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.

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E. WATER RIGHTS AND WATER FACILITIES

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1. Water Rights. This permit does not confer any water rights on the holder. The term “water rights” includes
all authorizations, such as certificates, reservations, decrees, or permits, for water use issued under state,
local, or other law. Any necessary water rights must be acquired by the holder in accordance with state law
and the terms of this permit. After this permit is issued, all water rights obtained by the holder for facilities that
divert or pump water from sources located on NFS lands for use on NFS lands, whether authorized or
unauthorized, are for the benefit of the United States and shall be acquired in the name of the United States.
Any expenses for acquiring water rights shall be the responsibility of the holder and not the responsibility of
the United States.

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2. Water Facilities. No ditch, reservoir, well, spring, seepage, or other facility to pump, divert, store, or
convey water (hereinafter “water facilities”) for which the point of diversion, storage, or withdrawal is on NFS
lands may be initiated, developed, certified, or adjudicated by the holder without prior written approval from
the authorized officer. The authorization of any water facilities in the permit area is granted to allow use of
water only in connection with the recreation residence authorized by this permit. If the use of any water
facilities in connection with this recreation residence ceases, the authorization to use any associated water
facilities also ceases. The United States reserves the right to place any conditions on installation, operation,
maintenance, and removal of water facilities that are necessary to protect public property, public safety, and
natural resources on NFS lands in compliance with applicable law. Any change in the beneficial use of or
location of use from a water facility without prior written approval from the authorized officer shall result in
termination of the authorization of that facility.

3. Water Rights Acquired in the Name of the Holder.

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(a) Identification of Water Rights. The holder has obtained the following water rights for use under this permit
in the holder’s name:
State ID #: _______________________________
Owner: __________________________________
Purpose of Use: ___________________________
Decree, License, or Certificate: _______________
Point of Diversion: ______________________
(b) Revocation or Termination. Upon revocation or termination of this permit, the holder shall transfer the
water rights enumerated in paragraph 3(a) to the succeeding permit holder for use only in connection with the
recreation residence authorized by this permit provided that if that recreation residence is not reauthorized,
the holder shall promptly petition in accordance with state law to remove from NFS lands the point of diversion
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and water use associated with the water rights or shall relinquish the water rights to the state where they are
located.
(c) Abandonment. Upon abandonment of the recreation residence authorized by this permit, any of the water
rights enumerated in paragraph 3(a) that remain in the name of the holder at the time of abandonment shall
be deemed to have been transferred to the United States to hold for the benefit of any succeeding permit
holder for use only in connection with that recreation residence; provided that if that recreation residence is
not reauthorized, the United States shall retain the water rights or relinquish them to the state where they are
located.
(d) Waiver. The holder waives any claims against the United States for compensation for any water rights
that are transferred, removed, or relinquished as a result of revocation or termination of this permit or
abandonment of the use authorized by this permit, or for compensation in connection with imposition of any
conditions on installation, operation, maintenance, and removal of water facilities associated with water rights
enumerated in paragraph 3(a).

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F. 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.
G. 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 NFS lands, fire
suppression costs, and destruction of or damage to federally owned improvements.

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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 is not
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 associated administrative, legal (including
attorney's fees), and other costs. Such costs may be deducted from a performance bond required under
clause IV.K.
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, assigns, agents, employees, contractors, or renters to the same extent as
provided under clause IV.G.1, except that liability shall not include reasonable and ordinary wear and tear.
H. 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.
I. ENVIRONMENTAL PROTECTION
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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.

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2. Definition of Hazardous Material. For purposes of clause IV.I 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.

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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 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, contractors, or renters 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.

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J. INDEMNIFICATION. 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 and occupancy authorized by this permit. This indemnification and hold
harmless provision includes but is not limited to acts and omissions of the holder or the holder’s family,
guests, invitees, heirs, assignees, agents, employees, contractors, or renters 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 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 hazardous material 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.
K. 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.

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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.

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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.

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L. FLOOD DAMAGE. The lands covered by this permit are in a floodplain or floodway. This permit is issued
with the specific understanding that if the authorized improvements are substantially damaged and made
uninhabitable by a flood, this permit shall terminate, and the remaining improvements shall be removed within
90 days. If damage to the improvements is not substantial, they may be repaired and allowed to remain if
they can be flood-proofed without affecting flows in the floodplain or floodway. No expansion of existing
improvements or new improvements will be allowed in the floodplain or floodway. No claim shall be made
against the United States for loss, damage, or termination of the permit due to a flood.
V. RESOURCE PROTECTION

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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 to address these
problems.
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
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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 NFS 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
Pesticide-Use 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 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.

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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.

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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 permit. The holder shall leave these discoveries intact and in place until otherwise directed
by the authorized officer.

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F. NATIVE AMERICAN GRAVES PROTECTION AND REPATRIATION (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 NFS 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 forest
authorized officer 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, ENDANGERED, AND SENSITIVE SPECIES 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, 16 U.S.C. 531 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 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
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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 occupancy. Discovery by the holder or the Forest Service of other sites within the permit area containing
sensitive species or species of conservation concern designated pursuant to FSM 2670 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. WATER WELLS AND ASSOCIATED PIPELINES

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1. Other Jurisdictional Requirements. Clause IV.E governs water rights and water facilities. The holder shall
obtain all required state and local water permits, licenses, registrations, certificates, or rights and shall provide
a copy of them to the authorized officer. For new wells, this information shall be provided prior to disturbing
NFS lands for the purpose of water use or development.

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2. Well Construction or Development. For new or reconstruction of existing wells, the holder shall prepare a
well construction and development plan and submit it to the authorized officer for approval. The well
development and construction plan must have prior written approval from the authorized officer before well
construction or development is initiated. The holder shall follow applicable federal, state, and local standards
for design, construction, and development of new wells or reconstruction of existing wells. If such standards
do not exist, the holder shall follow applicable standards issued by the American Society for Testing and
Materials (ASTM), American Water Works Association (AWWA), or National Ground Water Association
(NGWA). The construction and development plan must identify all potential sources for any proposed water
injection during well construction or development. Only non-chlorinated, potable water may be injected during
construction or development of wells to be used for monitoring or water withdrawal. Copies of all
documentation for drilling, constructing, or developing wells, including all drilling, boring, and well construction
logs, shall be provided to the authorized officer within 60 days of completion of work.

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3. Well Decommissioning. The holder shall properly decommission and abandon all wells that are no longer
needed or maintained in accordance with applicable federal, state, and local standards for water well
abandonment. If such standards do not exist, the holder shall follow applicable standards issued by the
ASTM, AWWA, or NGWA. At least 30 days prior to initiation of well decommissioning, the holder shall submit
a well decommissioning plan to the authorized officer. The well decommissioning plan shall have written
approval from the authorized officer before well decommissioning is initiated. All documentation of well
decommissioning shall be provided to the authorized officer within 60 days of completion of the work.
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. CABIN USER FEES AND DEBT COLLECTION
A. CABIN USER FEE. The annual cabin user fee shall be based on the recreation residence’s fee tier
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assignment. The recreation residence authorized by this permit has been assigned to Tier _____ with a
current-year annual cabin user fee of ______. The cabin user fee is due within 30 days of the date of billing.
The cabin user fee shall be adjusted annually based on changes in the Implicit Price Deflator for the Gross
Domestic Product, published by the Bureau of Economic Analysis of the United States Department of
Commerce, applied on a 5-year rolling average. Assignment to a fee tier is not subject to appeal pursuant to
36 CFR Part 214.
B. CABIN USER 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.

3. Late Payments

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2. Disputed Cabin User Fees. Cabin user fees are due and payable by the due date. Disputed cabin user
fees, other than cabin 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.

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(a) Interest. Pursuant to 31 U.S.C. 3717 et seq., interest shall be charged on any cabin user 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 cabin user 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 the cabin user fee, interest, or any other
charges within 90 calendar days of the due date. The holder shall remain responsible for the delinquent
charges.

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4. Administrative Offset and Credit Reporting. Delinquent cabin user fees and other charges associated with
the 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.
VII. RENTAL, NON-TRANSFERABILITY, AND SALE
A. INCIDENTAL RENTAL. With prior written approval from the authorized officer, the holder may rent the
recreation residence authorized by this permit for a limited number of short, specific periods for recreational
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purposes, provided the rental does not change the character or use of the authorized improvements from
noncommercial to commercial. The rental agreement must be in writing and must provide that the holder
remains responsible for compliance with all the terms of this permit. A copy of the rental agreement shall be
provided to the authorized officer.
B. NONTRANSFERABILITY. This permit is not transferable. A purchaser or transferee of the recreation
residence authorized by this permit must apply for and obtain a new permit from the Forest Service. A
transfer fee shall be charged to the holder per clause VII.D. A new permit for the recreation residence
authorized by this permit may be issued only to the owner of the recreation residence as of June 16, 1990; the
owner’s spouse; the children, stepchildren, and grandchildren of that owner and spouse; and their direct lineal
descendants (either natural or adopted offspring).

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C. PROSPECTIVE PURCHASERS AND TRANSFEREES. When the holder is contemplating a sale or
transfer of the recreation residence authorized by this permit, the holder shall notify the authorized officer and
provide a copy of this permit to the prospective purchaser or transferee. The holder shall not represent that
the Forest Service will issue a new permit to the prospective purchaser or transferee. Any purchaser or
transferee must apply for and obtain a new permit from the Forest Service. A new permit may be issued only
to an individual or a married couple.

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D. TRANSFER FEE. The holder shall pay a fee of $1,200, adjusted for inflation, for the issuance of a new
recreation residence permit due to a change of ownership of the recreation residence authorized by this
permit. The transfer fee shall be adjusted annually based on changes in the Implicit Price Deflator for the
Gross Domestic Product, published by the Bureau of Economic Analysis of the United States Department of
Commerce, applied on a 5-year rolling average.
VIII. REVOCATION, SUSPENSION, AND TERMINATION
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

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(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 VIII.A.2
and immediate suspension under clause VIII.C, the authorized officer shall give the holder written notice of the
grounds for revocation or suspension and a reasonable period, not to exceed 90 days, to cure any
noncompliance.
B. REVOCATION FOR SPECIFIC AND COMPELLING REASONS IN THE PUBLIC INTEREST. The
authorized officer may revoke this permit during its term if the Forest Service determines based on a land
management planning decision that the use and occupancy authorized by this permit should be changed for
specific and compelling reasons in the public interest, other than a determination under clause IV.F that the
authorized improvements or the permit area cannot be safely occupied. Prior to revoking the permit under this
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clause, the authorized officer shall give the holder 90 days written notice, provided that the authorized officer
may prescribe a shorter notice period if justified by the public interest. The Forest Service shall then have the
right to remove or relocate the authorized improvements, to require the holder to remove or relocate them, or
to purchase them. Removal or relocation by the Forest Service of the authorized improvements shall be
accepted by the holder in full satisfaction of all claims against the United States under this clause. If the
Forest Service requires the holder to remove or relocate the authorized improvements or purchases them, the
Forest Service shall be obligated to pay the lesser of (1) the cost of removal or relocation of the authorized
improvements or (2) the value of the authorized improvements as determined by the Forest Service through
an appraisal of their replacement cost, less an allowance for depreciation of all types. If that amount is fixed
by agreement between the authorized officer and the holder, that amount shall be accepted by the holder in
full satisfaction of all claims against the United States under this clause. If agreement is not reached, the
authorized officer shall determine the amount to be paid, which shall be set forth in the revocation decision. A
payment made pursuant to this clause is subject to the availability of appropriations. Nothing in this permit
implies that Congress will appropriate funds to cover a deficiency in appropriations.

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C. 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.

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D. APPEALS AND REMEDIES. Written decisions made by the authorized officer relating to administration
of this permit are subject to 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, other than as
provided in clause VIII.B.
E. 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 termination upon a change in ownership and issuance of a new
permit to another party for the recreation residence authorized by this permit. 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.

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1. Termination Upon Change in Ownership. If the holder through voluntary sale, transfer, enforcement of
contract, foreclosure, divorce, or other legal proceeding ceases to be the owner of the authorized
improvements, this permit shall terminate upon issuance of a new permit to another party for recreation
residence authorized by this permit. If the person who acquires title to the improvements is qualified to be a
holder under applicable regulations and Forest Service directives, that person shall be granted a new permit
for the remainder of the term of this permit.
2. Termination of a Permit Issued to a Married Couple or an Individual Upon Their Death
(a) Married Couple. If the holder of this permit is a married couple and one spouse dies, the permit shall
remain in effect, without amendment or revision, in the name of the surviving spouse.
(b) Individual or Surviving Spouse. If the holder of this permit is an individual or a surviving spouse and the
holder dies, this permit shall terminate. Pending settlement of the holder's estate, an annual renewable
permit, using form FS-2700-4, shall be issued to the executor or personal representative of the holder's
estate. Upon settlement of the estate, the authorized officer shall issue a new permit, updated as necessary
to reflect Forest Service policy changes, to a qualified heir or devisee for the remainder of the term of this
permit. To qualify, an heir or a devisee must be 21 years of age or older and the child, stepchild, or grandchild
of the owner of the recreation residence as of June 16, 1990, and that owner’s spouse, or their direct lineal
descendant (either natural or adopted offspring), and must have title to the recreation residence authorized by
this permit as shown by a court order, bill of sale, recorded will, or other legally sufficient documentation.
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IX. RIGHTS AND RESPONSIBILITIES UPON REVOCATION OR TERMINATION WITHOUT ISSUANCE
OF A NEW PERMIT
A. REMOVAL OF IMPROVEMENTS. Except as provided in clause VIII.B, upon revocation of this permit or
termination of this permit without issuance of a new permit, the authorized officer has the discretion to require
the holder to sell or remove all structures and improvements, except those owned by the United States, within
1 year and to restore the site to the satisfaction of the authorized officer. If the holder fails to sell or remove all
structures or improvements within 1 year, they shall become the property of the United States and may be
sold, destroyed, or otherwise disposed of without any liability to the 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 permit area.

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B. OFFER OF AN IN-LIEU LOT. Upon revocation (other than revocation for noncompliance), the authorized
officer may offer an in-lieu lot, if available, to the holder for building or relocating a recreation residence. An
in-lieu lot must be in a location that is consistent with the applicable land management plan in the same
National Forest as the authorized improvements or in an adjacent National Forest. An offer of an in-lieu lot
must be accepted within 90 days or within 90 days of final disposition of administrative appeal of the
revocation decision, termination when rebuilding is not allowed, or notification that a new permit will not be
issued upon permit expiration, whichever is later, or the offer will expire. Upon acceptance of an in-lieu lot,
this permit shall terminate.
C. CONTINUATION OF OBLIGATIONS AND LIABILITIES BEYOND TERMINATION OR REVOCATION.
Notwithstanding the termination or revocation of this permit, its terms and conditions 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.

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D. 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 Energy Regulatory 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 does not constitute revocation for specific and compelling
reasons in the public interest under clause VIII.B and shall not give rise to any claim for damages, including
lost profits and damage to improvements, by the holder against the Federal Energy Regulatory Commission,
the Bureau of Reclamation, the Forest Service, or hydroelectric power licensees.
X. 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.
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B. SUPERSEDED PERMIT. This permit replaces a special use permit issued to
, (PREVIOUS PERMIT #)
, on
(DATE OF PREVIOUS PERMIT)

.

(NAME)

C. DISCLAIMER REGARDING TITLE. Issuance of this permit shall not be construed as an admission by
the United States as to the title to any of the authorized improvements. The United States disclaims any
liability for issuance of a permit in the event of disputed title.
D. RULE OF CONSTRUCTION. If this permit is issued to a living trust and there is a conflict between any of
the terms of this permit and the terms of the trust documents or state law applicable to the trust, the terms of
this permit shall control.

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THIS PERMIT IS ACCEPTED SUBJECT TO ALL ITS TERMS.

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ACCEPTED:

#HOLDER_NAME#

DATE

#HOLDER_NAME#

DATE

APPROVED:

DATE

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#AUTHORIZED OFFICER NAME#
#TITLE#
National Forest
USDA Forest Service

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 March 4, 1915, 16 U.S.C. 497. 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

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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 March 4, 1915, 16 U.S.C. 497.
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

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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.

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

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