Fillable Fseprd533507 Palomar Wilderness Permit Application Submittal

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Fseprd533507 Palomar Wilderness Permit Application Submittal

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U.S.
Department of
Agriculture
Forest Service
WILDERNESS AND
VISITOR PERMIT
(Ref. FSM 2323)
FS-2300-30
(v 05-2013)
OMB NO. 0596-
0106
(15) TRAVEL PLAN
List or code all zones to be traversed, in sequence
of travel, and number of nights to be spent in each
zone.
In areas where specific campsites are assigned, list
and code each site and the number of nights
assigned.
TRAVEL
ZONES
(or campsite)
NIGHTS
Vehicle description:
WHEN SIGNED, THIS SINGLE – VISITOR PERMIT AUTHORIZES
(1) NAME (First, Middle Initial, and Last)
(3) CITY AND STATE
(4)
ZIP
COD
E
(5) TO VISIT (and to build campfires in accordance
with regulations)
(6) DATES (Give best estimates of
start and finish dates) From
month/day
Through
month/day
(7) LOCATION OF ENTRY POINT
(8) LOCATION OF EXIT POINT
NO WOOD OR CHARCOAL FIRES
VIOLATORS WILL BE CITED
(16) REMARKS:
THIS PERMIT DOE
S NOT
AUTHORIZE ACCESS ACROSS
NON-FOREST LAND
(Check Regulations – Vehicles not allowed in many permit
areas)
I agree to abide by all laws, rules and regulations which apply to this area and will
do my best to see that everyone in our group does likewise.
(14) VISITOR’S SIGNATURE
DATE
(17) ISSUING OFFICER’S SIGNATURE
0
2 5 3
FOREST
CODE
OFFICE CODE
VISITORS MUST HAVE PERMIT IN POSSESSION DURING STAY IN WILDERNESS OR REQUIRED PERMIT AREAS
FS-2300-30 (02/10)
Submit
Visitors Phone Number
Visitors Email Address
(make, model, year, color, and license)
(2) Address
click to sign
signature
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signature
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BURDEN AND NONDISCRIMINATION STATEMENTS
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 collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0596-0106. The time
required to complete this information collection is estimated to average 3 minutes per response.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities
on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual
orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons
with disabilities who require alternative means for communication of program information (Braille,
large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and
TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence
Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-
6382 (TDD).
USDA is an equal opportunity provider and employer.
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Fseprd533507 Palomar Wilderness Permit Application Submittal

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Completed 4 April 2020

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