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MISCELLANEOUS FOREST PRODUCTS PERMIT APPENDIX O-I MISCELLANEOUS FOREST PRODUCTS TRIBAL APPLICATION AND PERMIT APPLICANT'S NAME TRIBAL I.D. CARD NUMBER ADDRESS LIST ALL PARTIES ASSISTING IN GATHERING AND THEIR TRIBAL I.D. NUMBERS PRODUCTS TO BE GATHERED AMOUNT: LOCATION SIGNATURE OF APPLICANT DATE PERMIT The above tribal member is hereby authorized and permitted to gather the following miscellaneous forest product, subject to the conditions listed below: A. Amount of product to be gathered: B. Location in which gathering is permitted: C. Conservation or Public Health or Safety Provisions: Gathering may take place only in designated areas and, when applicable, only on designated trees. Access and use of equipment off the existing roads must be approved by the Director of the County Forestry Department in advance. D. All persons engaged in gathering miscellaneous forest products must be tribal members and possess a valid tribal identification card. E. Further Provisions: ---PAGE BREAK--- MISCELLANEOUS FOREST PRODUCTS PERMIT APPENDIX O-I F. Standard Provisions: The Tribal Member must possess this permit at all times while gathering or transporting the gathered miscellaneous forest product. While gathering or transporting any miscellaneous forest product, this permit, accompanying map(s) and a tribal identification card must be presented by the permittee upon request by any County representative. The permit holder assumes all responsibility to gather in designated area(s) only and to assure that he/she is on County property. The permit holder assumes all responsibility for his/her own protection and agrees to hold the County harmless for any accident or injuries sustained by him/herself or others in his/her party. All roads and trails shall be kept open at all times and may not be damaged. No skidding equipment may be utilized without written permission from the County. No permittee shall transfer this permit or allow the use thereof by any other person. Violations of this permit or any conditions of gathering stated herein shall be determined by the Director of the County Forestry Department and will result in the revocation of such permit. Violations may also subject the permittee to an assessment for any actual damage caused or prosecution for violation of 26.05 (timber theft) or 943.13 (trespass), Wisconsin Statutes, or other applicable statutes, county ordinances or rules. The permittee agrees to comply with the state timber theft, slash, fire, and litter laws. No gathering may be conducted during emergency forest fire bans. (10) Existing regeneration and/or residual trees may not be damaged. THIS PERMIT IS VALID FROM: UNTIL GATHERING AUTHORIZED UNDER THIS PERMIT MAY NOT BE CONDUCTED OUTSIDE OF THIS PERIOD I have read, understand, and agree to the conditions of this permit. Signature of Permittee Date Director, Douglas County Forestry Department Date