Form 299 - Application For Transportation And Utility Systems And Facilities On Federal Lands - 2009
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3STANDARD FORM 299 (05/2009)
APPLICATION FOR TRANSPORTATION AND
FORM APPROVED
Prescribed by DOI/USDA/DOT
UTILITY SYSTEMS AND FACILITIES
OMB Control Number: 0596-0082
P.L. 96-487 and Federal
ON FEDERAL LANDS
Expiration Date: 10/31/2012
Register Notice 5-22-95
FOR AGENCY USE ONLY
Application Number
NOTE:
Before completing and filing the application, the applicant should completely review this package and schedule a
preapplication meeting with representatives of the agency responsible for processing the application. Each agency may have
specific and unique requirements to be met in preparing and processing the application. Many times, with the help of the agency
Date Filed
representative, the application can be completed at the preapplication meeting.
1. Name and address of applicant (include zip code)
2. Name, title, and address of authorized agent if
3. Telephone (area code)
different from item 1 (include zip code)
Applicant
Authorized Agent
4. As applicant are you? (check one)
5. Specify what application is for: (check one)
a.
Individual
a.
New authorization
b.
Corporation*
b.
Renewing existing authorization No.
c.
Partnership/Association*
c.
Amend existing authorization No.
d.
State Government/State Agency
d.
Assign existing authorization No.
e.
Local Government
e.
Existing use for which no authorization has been received *
f.
Federal Agency
f.
Other*
* If checked, complete supplemental page
* If checked, provide details under item 7
6. If an individual, or partnership are you a citizen(s) of the United States?
Yes
No
7. Project description (describe in detail): (a) Type of system or facility, (e.g., canal, pipeline, road); (b) related structures and facilities; (c) physical
specifications (Length, width, grading, etc.); (d) term of years needed: (e) time of year of use or operation; (f) Volume or amount of product to be
transported; (g) duration and timing of construction; and (h) temporary work areas needed for construction (Attach additional sheets, if additional
space is needed.)
8. Attach a map covering area and show location of project proposal
9. State or Local government approval:
Attached
Applied for
Not Required
10. Nonreturnable application fee:
Attached
Not required
11. Does project cross international boundary or affect international waterways?
Yes
No
(if "yes," indicate on map)
12. Give statement of your technical and financial capability to construct, operate, maintain, and terminate system for which authorization is being
requested.
STANDARD FORM 299 (REV. 5/2009) PAGE 1
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