(NPS Form 10-930)                                                                                                                                                          (OMB No. 1024-0026)

(NEW 12/99)                                                                                                                                                                     (Expires 08/31/2001)

National Park Service

Redwood National and State Parks

       Application for Special Use Permit

 

Please supply the information requested below.  Use additional sheets if necessary.  Allow at least four (4) business days for processing.  A non-refundable processing fee may be required to accompany this application unless the requested use is an exercise of a First Amendment right. You will be notified of the disposition of the application and the necessary steps to secure your final permit. (Note: there may be additional fees charged, and you may be required to provide proof of liability insurance.)

 

Applicant Name:                                                                                        Social Security #______________                            

Organization Name (if applicable):_________________________________________________________

 Tax ID #____________________________________________________________________________                                                                                

Street/Address:_______________________________________________________________________                                                                                                                                                     

City/State/Zip Code:____________________________________________________________________                                                                                                                                              

Telephone number:_____________________________________________________________________                                                                                                                                            

Description of Proposed Activities:_________________________________________________________ ___________________________________________________________________________________                                                                                                                  

Requested Location: ___________________________________________________________________                                                                                                                                          

Date (s):                                                          Set-up will begin at_________________________________                                                               

Event will begin at:                                        _____________________________ Removal will be completed

by _________________________________________________________________________________                                           

Maximum Number of Participants                                                                      (Please provide best estimate)

Maximum Number of Vehicles                                                                                         (attach parking plan)

Support Equipment (generators, amplification, etc.):                                                                                                                                                                               

                                                                                                                                                                         

Support Personnel (contractors, etc.) _______________________________________________________                                                                                                                

 

Individual (if other than applicant) in charge of event on site:                                                                                                                                                      

 

Is this an exercise of First Amendment Rights?                                         Y         N

Are you familiar with/ have you visited the requested area?                                  Y         N

Do you plan to advertise or issue a press release?                                                Y         N

Will you distribute printed material?                                                                     Y         N

Is there any reason to believe there will be attempts to disrupt,

      protest or prevent your event?(if yes explain on separate sheet)                      Y         N

 

The applicant by his or her signature certifies that all the information given is complete and correct, and that no false or misleading information or false statements have been given.         

 

 

Signature                                                                                                      Date                                            

 

Return this application to:            Janet Cooper

                                                  Permit Coordinator

                                                  Redwood and State Park

                                                  1111 2nd Street

                                                   Crescent City, CA 95531 

              Phone (707)  464-6101 Ext. 5056         Fax (707) 465-5171

 

 

Paperwork Reduction Act Statement:  This information is being collected to allow the park manager to make a valued judgement on whether or not to allow the requested use.  All the applicable parts of the form must be completed.

 

Estimated Burden Statement:  Public reporting burden for this form is estimated to average 30 minutes per response including the time it takes to read, review instructions and complete the form.  Direct comments regarding this burden estimate or any aspects of this form to the National Park Service Program Manager, Special Park Uses, Ranger Activities Division, 1849 C Street, NW., Washington, D.C. 20240 and  to the Information Collection Clearance Officer, Washington Administrative Program Center, 1849 C Street, NW., Washington, D.C. 20240.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.

____________________

Standard application fees.  The following standard application fees are established, based on the relative size and complexity of the use or event requested, and will be charged to all short-term Special Use Permit applicants.

 

Small Use/Event:  $80.00

 

              Typically, an activity having fewer than 50 people participating; of less than five hour duration; with little negotiation needed; an obvious categorical exclusions under NEPA and Section 106; that will require only a standard permit with generic conditions, or that will result in little or no additional workload by RNSP staffs involved other than processing the applications.  Examples:  outdoor weddings, group picnic.

 

Moderate Use/Event:  $225.00

 

              Typically, an activity have 50-100 people participating; where minor traffic problems are anticipated; of longer than five hours in duration; some negotiation on terms and conditions of the permit is needed; possibly some limited compliance work is needed, but the event is considered a categorical exclusion under NEPA and Section 106; or may attract press and/or, significant numbers of observers, etc.  Examples:  endurance horse ride, smaller athletic event, etc.

 

Large Use/Event $700.00

 

              Typically, an activity having more than 100 people participating, large number of vehicles involved; where traffic problems are anticipated that will necessitate traffic control; or significant logistics or support activities are required; significant negotiations on terms and conditions are required; or a full project review process is needed to complete NEPA and Section 106 compliance.  Examples:  Large privately sponsored run/walk or bicycling event, activities which propose damages to park resources such as cutting trees, digging holes, etc.

 

Because of our State and National Park’s partnership the administrative/application permit fee may be split, depending on the location of your event.  When your event is scheduled in the state park sectors please split your fee payment; one check is made payable to the California Department of Parks and Recreation and the other check is made payable to the National Park Service. Thank you.