Road Use Permit Application

ROAD USE PERMIT APPLICATION

For Industrial Use of a Forest Service Road

/
Date:
Name of Applicant:
Tenure No.(s)
Address:
Telephone: / Fax:
E-Mail Address:

This application is for the use of those Forest Service roads which are shown on the attached Schedule A or map, for the purpose of:

forest-related industrial use
non-forest industrial use (specify)

Vehicle Size

The dimensions and weights of vehicles to be used on the road shall either

Conform to MOT Regulations

Be Off-Highway, as per the option shown on the attached (Schedule A)

Estimated maximum number of loads per day

Approximate start date and estimated completion date

Where there is another permittee required to carry out the maintenance, I acknowledge that I will be expected to notify and reach agreement with that permittee to share road maintenance responsibilities, including costs. I am aware that the District Manager may require me to carry out road maintenance on any or all of the roads for which this application is made.

Applicant's Signature

Print Name

FS 109 HRT03/06

ROAD USE PERMIT

SCHEDULE A

Date: File:

FSR Name/Project Number / FSR Branch No. / Section to be Used / If Off-Highway, Indicate Vehicle Size
A, B, or C
From Next Section / MOF USE ONLY
Road Use Permit holder required by district manager to maintain the FSR
Name/telephone number
km to km

The dimensions and weights of vehicles not indicated for off-highway use shall conform to Ministry of Transportation

FS 109 HRT03/06

SCHEDULE A (continued)

Off-Highway Vehicle Size

The dimensions and weights of vehicles to be used on the road(s) shall conform to option A, B, or C and be shown on previous section.

Length: / m / Overhang beyond rear trailer bunk: / m
Width: / m / Weight Axle (Tandem): / kg
Height: / m / GVW: / kg

FS 109 HRT03/06