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04/26/2010 MON 10:35 FAX 9708842428 Columbine Public Lands <br />0004/005 <br />the United States, and shall restore the site within 60 day(s), unless otherwise agreed upon in writing. If the holder fails to <br />remove the improvements, they shall become the property of the United States, but that will not relieve the holder of <br />liability for the cost of their removal and restoration of the site. <br />14. This permit is a license for the use of federally owned land, It does not grant any interest in real property. This permit <br />is not transferable. The holder shall not enter into any agreements with third parties for occupancy of the authorized <br />premises and improvements. <br />15. Appeal of any provisions of this permit or any requirements thereof shall be subject to the appeal regulations at 36 <br />CFR 251, Subpart C, or revisions thereof. <br />16. This permit is accepted subject to the conditions set forth herein, conditions 1-17 and Exhibits A attached to and <br />made a part of this permit. <br />17. The above clauses shall control if they conflict with additional clauses or provisions. <br />1 have read and understand the terms and conditions and agree to abide by them,.. <br />HOLDER <br />By: 0114V'10 ' e;~'Ci <br />i" 4V e .4 <br />ids"•?:31to,i ?rcL•.,n„r'f.?,, i, <br />Address: 613 5'he y''f^ "v) S <br />Phone #: 36°3 - `i 6 3 0 x /L7 <br />Date: <br />0 <br />U. S. DEPARTMENT OF AGRICULTURE <br />Forest y$ ;r ice <br />B <br />Name: MATT JANOWIAK <br />Title: District Ranger <br />(Authorized Officer) <br />Date: <br />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 <br />collection of Information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596- <br />0082. The time required to complete this information collection is estimated to average one (1) hour per response, including the time for <br />reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the <br />collection of information <br />The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national <br />origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic <br />information, political beliefs, reprisal, or because all or part of an individual?s income is derived from any public assistance. (Not all <br />prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information <br />(Braille, large print, audiotape, etc.) should contact USDA?s TARGET Center at 202-720.2600 (voice and TOD). <br />To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250- <br />9410 or call toll free (866) 632-9992 (voice). TOD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) <br />or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer. <br />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 <br />received by the Forest Service.