BLM Wyoming

These forms are obsolete

U.S. DEPARTMENT OF THE INTERIORBUREAU OF LAND MANAGEMENT
Wyoming

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Request for Wildlife Exception

You must select one "Project Category."
Project Category:	Fluid minerals/APD	Realty action/ROW	Other
Note: please use a period as a separator instead of a hypen or slash (e.g. 10.03.08 instead of 10-03-08 or 10/03/08)
Project Information Provided by Proponent

Project Name:	Request number:	Date submitted:
Company/Group requesting exception:
Project Contact Name:	Title:
Phone Number:	Email:
BLM Contact Name (NRS, Realty, Range):

Type of Project: Fluid minerals/APD Realty action/ROW Other

Lease or Case File Number:
Location:	¼ ¼	Section:	Township North	Range West
Date Action (APD/ROW) Approved:
Spud Date/Proposed Start Date:
Exception Requested Until Date (approval limited to 14 days):
Affected Resources (check all that apply within request time period)
Crucial Winter Range
Raptor Nesting (list species if known):
Sage-grouse
Mountain plover
Parturition/Calving/Lambing Habitat
Other Species or Seasonally Restricted Habitats (list if known):

Statement of Work
Statement of need for the exception, including alternatives considered & impact of delay:
Actions/construction to be completed, including workforce & equipment required:
Anticipated start date & time frame required for actions/construction:
Next logical stopping point:

Attachments:
To send via email, click here.
Or fax to 307-328-4373 with "Exception Request" as the subject.

Quality map

Additional activity descriptions

Other

Additional Information?

Please contact BLM_WY_WebTeam@blm.gov if you receive an error message after clicking "Submit."