(SHOW A DESCRIPTION OF THE LOAD OR
EQUIPMENT AND MODEL NO. - INCLUDE DIMENSIONS OF LOAD)
Authorization is granted for the following:
Haul
Drive
Load
DESCRIPTION OF HAULING
EQUIPMENT:
VEHICLE WIDTH:
KINGPIN TO LAST
AXLE:
COMB. VEHICLE
LENGTH:
AXLE
NUMBER
MAXIMUM
ALLOWABLE WEIGHT
LOADED
DIMENSIONS GREATER THAN THOSE SHOWN BELOW OR WEIGHTS
EXCEEDING THOSE SHOWN ABOVE ARE NOT AUTHORIZED.
LOADED
HEIGHT:
LOADED
WIDTH:
LOADED
OVERALL LENGTH:
LOADED
OVERHANG:
WEIGHT
CLASS:
ORIGIN:
DESTINATION:
PREFERRED
ROUTE
AUTHORIZED
STATE HIGHWAYS - CITY AND/OR STATE PERMITS ARE REQUIRED
WHEREVER THE * IS SHOWN IN THE STATE ROUTE
PILOT CAR:
YES
NO
* CREDIT
CARD NUMBER
EXPIRATION DATE
REQUESTED
ROUTE (Include Address of Origin and Delivery Site)
CONTACT
PERSON
DATE
* This form can NOT be submitted
by email.
Complete, then print this form
and fax it to 831.646.3474.
( To print, choose File, then Print )
For questions, contact: Traffic Engineer
Richard Deal
at 831.646.3470
or Field Assistant
Bonnie Young
831.646.3473