Application for transportation and utility systems and facilities on federal lands

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TANDARD FORM 299 (6/99)


P.L. 96-487 and Federal OMB NO. 0596-0082

Register Notice 5-22-95


NOTE: Before completing and filing the application, the applicant should completely review this package and Application Number:

schedule a pre-application 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 Date Filed:

processing the application. Many times, with the help of the agency representative, the application

can be completed at the pre-application meeting.

1. Name and address of applicant (including zip code) 2. Name, title and address of authorized agent 3. Telephone (area code)

if different from item 1 (include zip code)


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. Non-returnable 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.

(Continued on reverse side) This form is authorized for local reproduction.

13a. Describe other reasonable alternative routes and modes considered.

b. Why were there alternatives not selected?

c. Give explanation as to why it is necessary to cross Federal Lands.

  1. List authorizations and pending applications filed for similar projects which may provide information to the authorizing agency (Specify number, date

code or name)

  1. Provide statement of need for project, including the economic feasibility and items such as: (a) cost of proposal (construction, operation and

maintenance); (b) estimated cost of next best alternative; and (c) expected public benefits.

16. Describe probable effects on the population in the area, including the social and economic aspects, and the rural lifestyles.

17. Describe likely environmental effects that the proposed project will have on: (a) air quality; (b) visual impact; (c) surface and ground water quality and

quantity; (d) the control or structural change on any stream or other body of water; (e) existing noise levels; and (f) the surface of the land, including

vegetation, permafrost, soil and soil stability.

  1. Describe the probable effects that the proposed project will have on (a) populations of fish, plant life, wildlife and marine life, including threatened and

endangered species; and (b) marine mammals, including hunting, capturing, collecting or killing these animals.

  1. State whether any hazardous material, as defined in this paragraph, will be used, produced, transported or stored on or within the right-of-way or any

of the right-of-way facilities, or used in the construction, operation, maintenance or termination of the right-of-way or any of its facilities. “Hazardous material” means any substance, pollutant or contaminant that is listed as hazardous under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, as amended, 42 U.S.C. 9601 et seq., and its regulations. The definition of hazardous substances under CERCLA includes any “hazardous waste” as defined in the Resource Conservation and Recovery Act of 1976 (RCRA), as amended, 42 U.S. C. 6901 et seq., and its regulations. The term hazardous materials also includes any nuclear or byproduct material as defined by the Atomic Energy Act of 1954, as amended, 42 U.S.C. 2011 et seq. The term does not include petroleum, including crude oil or any fraction thereof that is not otherwise specifically listed or designated as a hazardous substance under CERCIA Section 101(14), 42 U.S.C. 9601(14), nor does the term include natural gas.

20. Name all the Department(s)/Agency(ies) where this application is being filed.

I HEREBY CERTIFY, that I am of legal age and authorized to do business in the State and that I have personally examined the information contained in the application and believe that the information is correct to the best of my knowledge.

Signature of Applicant Date

Title 18, U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction.

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