APPENDIX I 



PERMIT FORM USED IN THE SPANISH PEAKS 

 PRIMITIVE AREA 



U.S. Department of Agriculture 

 U. S. Forest Service 



Name 



Self-Issuing 

 WILDERNESS PERMIT 



Address 



Citv 



State 



To visit 



(NAME OF WILDERNESS) 



Give best estimate of start 

 and finish dates 



FROM 

 MO. /DAY 



THROUGH 

 MO. /DAY 



Location of entry. 

 Location of exit 



Primary method of travel- 



Number of people in group. 



Number of pack or saddle stock. 



Numbei of watercraft or other craft . 

 LIST PLANNED CAMP AREAS 



DATE 



(PLEASE DO NOT WRITE IN CROSS HATCHED SPACE) 



I agree to abide by all laws, rules, and regulations which apply to this area, 

 I will do my best to see that everyone in my group does likewise. 



(DATE) 



(SIGNATURE) 



Remarks 



U.S. Department of Agriculture, Forest Service 



Keep the white copy in your possession while in the wilderness. 

 Please place yellow copy in nearby receptacle. 



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