PERMFILE105946

• Permit No: M1978002
• IBM Index Class Name: Permit File
• Doc Date: 1/3/1978
• Doc Name: LIMITED IMPACT & SPECIAL 10-DAY PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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NOTICE
T'ne Privacy Act of 1974 and the regulation in 43 CFR 2.48(d)
provide that you be furnished the following information in
connection with in[ormation required by this application.
AUTHORITY: 30 U.S.C. 601, 602; 43 U.S.C. 1201; 60 Stat. 367
PRINCIPAL PURPOSE -The information is to be used to
process your application for a Free Use Permit.
ROUTINE USES:
(1) The adjudication of the applicants' rights to the land
or resources.
(2) Documentation for public information in support of no-
tations made on land status records for the management,
disposal, and use of National Resource lands and
resources.
(3) Transfer to appropriate Federal agencies when concur-
rence is required prior to granting a right in National
Resource lands or resources.
(4) Transfer to the U.S. Department of Justice in the event
of litigation involving the records or the subject matter
of the records.
(S) Transfer, in the event there is indicated a violation or
potential violation of a statute, regulation, rule, order
or license, whether civil, criminal or regulatory in nature,
to the appropriate agency or agencies, whether Federal,
State, local or foreign, charged with the responsibility
of investigation or prosecuting sucfi violation or charged
with enforcing or implementing the statute, rule, regu-
lation, order or license violated or potentially violated.
EFFECT OF NOT PROVIDING INFOR~+AATIOIV - If you do not
furnish all the information required by this form, your application
may be rejected.
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