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• <br /> <br />• <br /> <br />STANDARD FORM 299 (22003) i <br />Prescribed by D011USDA/DOT <br />P.L. 96487 and Federal <br />FORM APPROVED <br />rte ire. Ne6- 5-22-95 APPLICATION FOR TRANSPORTATION AND OMB NO. 1004-0189 <br />Expires: October 31 <br />2W5 <br /> . <br />UTILITY SYSTEMS AND FACILITIES <br /> ON FEDERAL LANDS <br /> FOR AGENCY USE ONLY <br />NOTE: Before completing and filing the application, the applicant should completely review this package and schedule a Application Number <br />preapplication meet i g with representatives of the agency responsible for processing the application. Each agency <br />may have specific a nd unique requirements to be.met in preparing and processing the application. Many times, with Date filed <br />the help of the agen representative, the application can be completed at the preapplicanon meeting. <br />1. Name and address of ap licant (include zip code) 2. Name, title, and address of authorized agent if different 3. TELEPHONE (area code) <br /> <br />f(pc?? 1t/C i• >?iw r ? <br />: Li?,??' ) ?: ai Q t itK from Item I (include zip code) <br />, <br /> <br />' (?:_c-S r <br />ttilti (I - <br />L <br />Z <br /> <br />Applicant <br />t tc - <br />?trlr? <br />,23c Authorized Agent <br /> <br />4. As applicant are you? ( I heck one) 5. Specify what application is for. (check one) <br />a. ? Individual a. ? New authorization <br />b. ? Corporation b. ? Renewing existing authorization No. <br />C. 0 Partnership/ sociation• c. ? Amend existing authorization No. <br />d. ? State Gov em/State Agency d. ? Assign existing authorization No. <br />C. ? Local Gov ent e- ? Existing use for which no authorization has been received$ <br />f ? Federal Age f. ? Other <br />• ,((checked, complete plemeraal page • lfchecked, provide details under Item 7 <br />6. If an individual, or partr ership are you a citizen(s) of the United States? ? Yes ? No <br />7. Project description (des be in derail): (a) Type of system or facility, (e.g., canal, pipeline, road); (b) related structures and facilities; (c) physical specifications <br />(length, wh*& gmding, etc.); (d) term of years needed; (e) time of year of use or operation; (I) Volume or amount of product to be transported; (g) duration and <br />timing of construction; d (h) temporary work areas needed for construction (Attach additional sheets, ifadk bona! space is needed) <br />Z' C C:?r'h'hCr-,Lk ( 2.?:? 1 C 1'a le r.; <br />>+e 13 L r L, <br />. <br />L. (- U. 6u: - / / k7 /Yh•a /ice i?.rrr,;: <br />ry s/' 1%=E9C-t3 <br /> . <br /> <br />Sc?rcx:? jam. r,(( ? Z cow ??r17 <br /> <br />:) r Ext <br />10 1 <br />8. Attach a map covering i sea and show location of project proposal G ./ <br />9. State or local governme nt approval: ? Attached ? Applied for U- of required <br />10. Nonreturnable applicati n fee: ? Attached ? Not required <br />H. Does project cross inte ational boundary or affect international waterways? ? Yes Q'No t7f'yes,"indicate on map) <br />12. Give statement ofyour hnical and financial capability to construct, operate, maintain, and terminate system for which authorization is being requested. <br />?"?Lr., I?'? /??.•i. iA/? 7i1? '.?I?'G°J/%/Z LGi',i)%T?•'/lJ.li ?'G` ??i L:i: (/ELF 7fr?U.:.I 9y-?. S'. .jN 4W Z?G?7 <br />G:i? c'.-?v Z'?+LaZ,r?*L /?-Zc'3k'iwzt.•, ??1?•?'Yi?7*r?- ?" /YI.n.,,,rr.,rv i4-Glc?s' ?'?.•?3, <br />(Continued on page 2) This form is authorized for local reproduction. <br />'rL" CG'