The Michigan Department of Natural Resources mandates the use of the PR1138-1 form, an essential tool for individuals or organizations seeking authorization to utilize state lands for various activities. Governed by the authority of Part 5 of Act 451 of 1994, as amended, this form constitutes an intricate component of the legal framework that oversees the conservation and utilization of natural resources within Michigan. It meticulously outlines the application process, setting a precedent that all submissions must be forwarded to the local DNR office at least sixty days before the proposed use date. Alongside the initial application, a fee of fifty dollars is required, emphasizing the form's role in facilitating a standardized approach to land use that ensures both the conservation of natural resources and public enjoyment. Additionally, the form delves into specifics such as duration of land use, types of activities permitted, and comprehensive conditions and requirements including insurance, performance bond, and adherence to environmental laws. This ensures that activities conducted on state lands not only align with conservation goals but also meet safety and legal standards, further illustrating the form's significance in managing state land use.
| Question | Answer |
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| Form Name | Form Pr1138 1 |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | 1976, michigan dnr pr1138 1, MCL, 2007 |
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IC HIGA |
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Michigan Department of Natural Resources
APPLICATION/PERMIT TO USE STATE LAND
This information is required under authority of Part 5 of Act 451 of 1994, as amended, MCL 324.501- 511 and the Rules for the Regulation of State Lands, R299.921 – R299.932.
DNR USE ONLY
Management Unit
Permit Number
APPLICANT: Please read all attachments before completing application. Submit completed application to local DNR office where permit is being sought. Application must be submitted at least sixty (60) days prior to proposed use. Attach additional information as needed to fully describe proposed use activity. Checks or money orders should be made payable to “State of Michigan.”
•For Application/Permit to Use State Land for an Event, use DNR PR1138.
•Initial application fee of fifty dollars ($50.00) must be submitted with application.
Name of Applicant/Organization |
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Name of Contact Person |
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Address |
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Address |
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City, State, ZIP |
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City, State, ZIP |
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Telephone |
FAX |
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Federal ID Number |
Telephone |
FAX |
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Proposed location on state land (name of trail or Department facility or legal property description, and attach map, subject to correction by Department):
Length of Use |
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Seasonal/Periodic |
Annual |
Other: |
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Date(s) of Proposed Use |
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No. of Participants/Users |
No. of Recreational Units (Camping) |
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Will the use of state land require or include: |
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use of parking lot/campground/access site? |
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No |
Yes |
If Yes, explain: |
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structures or equipment be placed on state land? |
No |
Yes |
If Yes, explain: |
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sound amplification equipment be used? |
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No |
Yes |
If Yes, explain: |
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food, beverages or other items be sold? |
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No |
Yes |
If Yes, explain: |
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alcohol be served or consumed? |
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No |
Yes |
If Yes, explain: |
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use of utilities (water, electric, sewer) ? |
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No |
Yes |
If Yes, explain: |
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Type of Use |
Geocache |
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Guiding |
Oil & Gas |
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Road Construction |
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Seismic Survey |
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Watercraft |
Other (specify) |
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Description of Proposed Type of Use (Attach additional information as needed to fully describe proposed use activity.) |
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APPLICANT: Read all pages and attachments before certification and signature.
APPLICANT CERTIFICATION
I certify that the information submitted herein, including all attachments, is accurate and complete and that I have read and understand and agree to abide by the requirements contained on all attachments, including liability insurance and performance bonding requirements. I have enclosed the required Application Fee. I understand that, if I have submitted a Review Fee that is not the correct amount, an additional fee must be paid prior to review of my application. I also understand that all remaining fees for the use of the State Land must be received by the Department within 14 days of notification of approval to the applicant or permissions may be considered void.
Applicant/Authorized Representative - Print or TypeSignatureDate
FOR DNR USE ONLY
Management Unit |
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County |
Performance Bond Type |
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Receipt No. |
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Other Charges |
Receipt No. |
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Surety |
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Cash |
$ |
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$ |
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Review Fee |
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Receipt No. |
Application Fee |
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Receipt No. |
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Use Fee |
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Receipt No. |
Timber Consideration Fee |
Receipt No. |
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$ |
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$ |
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$ |
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$ |
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Insurance Aggregate Amount |
Date Permit Issued |
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Date Permit Expires |
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Applicant / Permit Number |
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$ |
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Department Representative (please print) |
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Telephone (with area code) |
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Signature |
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Address |
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ADDITIONAL REQUIREMENTS: As contained in the attached Exhibit(s). |
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DISTRIBUTION: |
ORIGINAL – Land Administering Division(LAD), Lansing |
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Page 1 of 3 |
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COPY – Applicant/Permittee, LAD Mgt Unit, LAD District |
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CONDITIONS AND REQUIREMENTS
1.Permit shall be available for inspection when Permittee is operating on
2.Permission for use shall expire on the date indicated, unless sooner terminated.
3.Payment in the amount specified shall be made prior to use of land, or in installments as indicated.
4.Permittee shall maintain the area under Permit in a clean and orderly condition.
5.Requests for Permit renewals should be made to the Department thirty (30) days prior to the expiration date of this Permit. Such requests will be considered only when all stipulations in the original Permit have been complied with.
6.The rights accruing under this Permit shall not be assigned or transferred without the written permission of the Department Representative.
7.Permittee shall not commit, cause, or allow to be committed, any waste of, or injury to, said premises or any part thereof, nor use the same except for the purpose indicated.
8.Temporary improvements may only be made if further authorized under the conditions of this Permit, or by separate written permission of the Department Representative.
9.Improvements made by the Permittee on said premises and not removed within 30 days after cancellation or expiration of this Permit, and when such removal shall be requested by the Department, AT THE DEPARTMENT’S OPTION, shall become attached and remain a part of the premises.
10.The Department reserves the right to:
a.dispose of any portion of the premises herein described during the term of this Permit. If possible, proper notice of sale or disposition will be given Permittee. However, failure to notify Permittee will not affect this right.
b.lease said premises for exploration and production of any or all minerals, including coal, gas, oil, sand, gravel, etc.
c.grant
11.Permittee and occupants are responsible for the payment of all utility bills including water, electricity, gas, etc.
12.Permittee agrees to comply with all requirements herein, and, if for any reason Permittee violates or neglects to fulfill such requirements, this permission for use shall terminate and Permittee shall forfeit all rights and payments made hereunder. Should
Permittee remain in possession of said premises after cancellation or expiration of this Permit, said Permittee shall be considered as tenant or tenants holding over without permission and may be evicted from said premises.
13.Permittee shall comply with all applicable (including but not limited to all environmental) laws, regulations and codes and will obtain any necessary Permits in connection with its use of the Premises.
14.Permittee shall reimburse the Department for any repairs to the Premises resulting from damage.
15.Permittee shall report, in writing, to the Department Representative, all incidents related to the use of this Permit that result in personal injury, death, or property damage. Incidents resulting in personal injury, death, or property damage (estimated to exceed $300.00) must be reported to the Department Representative immediately by telephone or in person, followed by a written report.
16.The Department shall have the right at all reasonable times during the term of this Permit to enter the premises for the purposes of making any inspections, repairs, additions or alterations as may be deemed appropriate by the Department for the preservation of the Premises.
17.Permittee shall comply with the
18.Permittee shall comply with the Employers Engaging in Unfair Labor Practices Act, 1980, PA 278, as amended, MCL 423.321 et seq., MSA 17.458 (21) et seq.
19.There shall not be any disturbance to survey corners and associated witness trees.
DISTRIBUTION: |
ORIGINAL – Land Administering Division(LAD), Lansing |
Page 2 of 3 |
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COPY – Applicant/Permittee, LAD Mgt Unit, LAD District |
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CONDITIONS AND REQUIREMENTS (CONT’D)
20.INSURANCE: Applicant shall furnish to the Department, prior to issuance of written permission, a policy of liability insurance which provides as follows:
a.Names of Insured, the Applicant, its officers, employees, and agents;
b.Coverage against all known and unknown hazards arising from the acts and omissions of the Applicant, its officers, employees, and agents;
c.Coverage for Applicant’s contractually assumed obligation to indemnify and hold harmless the State of Michigan, its departments, officers, employees and agents;
d.A term of coverage for not less than the term of use;
e.Liability insurance coverage with respect to personal injury, death, and property damage to the limits described in the Guidelines for Liability Insurance Requirements for User Groups;
f.That the policy will not be cancelled, or its provisions modified or deleted, unless and until the insurer first sends thirty (30) days’ written notice to the Department representative shown on permit.
21.PERFORMANCE BOND: A cash or surety bond shall be provided by Applicant, as a guarantee of faithful performance of the conditions of the Permit, prior to issuance of the Permit. As soon as security for the performance of the terms and conditions of the Permit or the settlement of claims incident thereto is no longer necessary, deposits in lieu of surety or cash bond will be returned to the Applicant/Permittee.
22.CAMPINGOUTSIDEADESIGNATED CAMPGROUND: If camping involves five or more sites
23.CUTTING OR REMOVAL OF TREES/VEGETATION: Cutting or removal of trees/vegetation within the Permit area shall occur only if specifically authorized, in writing, by the Department Representative. The fee to cut or clear the authorized location shall be paid prior to cutting and clearing activities by the Permittee at the Department of Natural Resources’ standard fee schedule rates.
24.Permittee shall take all reasonable precautions to prevent and suppress forest fires.
25.BRUSH, STUMPS, OR DEBRIS: All brush, stumps, or debris resulting from operations under this Permit shall be disposed of as directed by the Department Representative.
26.BRIDGES, CULVERTS, CORDUROY: No bridges, culverts, corduroy, or other road improvements made by Permittee on said premises shall be removed unless authorized in writing by the Department Representative.
27.DAMAGES: The Permittee shall be held liable for any damages caused by operations under this Permit which may arise to forest growth, fences, crops, buildings or other improvements on State- owned property. This shall be as determined by the Department Representative.
28.ADDITIONAL REQUIREMENTS: Permittee shall review any additional site specific or use specific requirements (Exhibits) provided by the Department and ascertain agreement by Permittee’s authorized representative’s signature and date on each Exhibit. This Permit shall not be effective until such agreement is made.
29.LIABILITY: Permittee hereby releases, waives, discharges and covenants not to sue the State of Michigan, its departments, officers, employees and agents, from any and all liability to Permittee, its officers, employees and agents, for all losses, injury, death or damage, and any claims or demands therefore thereto, on account of injury to person or property, or resulting in death of Permittee, its officers, employees or agents, in reference to the activities authorized by this Permit.
30.INDEMNIFICATION: Permittee hereby covenants and agrees to indemnify and save harmless, the State of Michigan, its departments, officers, employees and agents, from any and all claims and demands, for all loss, injury, death or damage, that any person or entity may have or make, in any manner, arising out of any occurrence related to (1) issuance of this Permit; (2) the activities authorized by this Permit; and (3) the use or occupancy of the premises which are the subject of this Permit by the Permittee, its employees, contractors, or its authorized representatives.
31.PENALTY NOTICE:
DISTRIBUTION: |
ORIGINAL – Land Administering Division(LAD), Lansing |
Page 3 of 3 |
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COPY – Applicant/Permittee, LAD Mgt Unit, LAD District |
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