overload_permit_form.pdf
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- Attached to
- Perry Pit Crush and Stockpile: Federal contract opportunity
- Solicitation number
- 12837119R0016
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Overload Permit
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| 12837119R0016.pdf |
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Text version
U.S. DEPARTMENT OF AGRICULTURE – FOREST SERVICE
APPLICATION AND PERMIT FOR ROAD OPERATIONS
36CFR 261.10(a), 261.12 and 261.50
DATE RECEIVED: ___________________
PERMIT NO. _______________________
EFFECTIVE DATES OF PERMIT:
BEGINNING: _____________________
TERMINATING: ___________________
EXCLUDING: _____________________
PERMITTEE/APPLICANT: ______________________________________ PHONE: _______________ ADDRESS: __________________________________________________________________________ IF PERMIT IS FOR A TIMBER SALE, SALE NAME: __________________________________________ DESIRED TRAVEL DATES: BEGIN: ___________ END: __________ (ALLOW 7 DAYS MIN FOR APPROVAL) DESIRED TRAVEL ROUTE:_____________________________________________________________
ATTACH MAP AND LIST BRIDGES
TYPE OF VEHICLE: ___________________________________________________________________
TOTAL GROSS WEIGHT: _____________ POUNDS LICENSE NO. ___________ STATE _____
MAXIMUM DIMENSIONS: LENGTH: ______________ WIDTH: ____________ HEIGHT: ___________
VEHICLE DESCRIPTION
AXLE WIDTH TIRE WIDTH (OUT-OUT) NO. OF
AXLE AXLE SPACING AXLE LOAD (OUT – OUT) PER WHEEL LINE TIRES TIRE
NO. FEET & INCHES POUNDS FEET INCHES INCHES PER AXLE SIZE
1 P1 ___________ _____ ′ _____ ″ _______ ″ _____ _______ D1 _____ ′ _____ ″ 2 P2 ___________ _____ ′ _____ ″ _______ ″ _____ _______ D2 _____ ′ _____ ″ 3 P3 ___________ _____ ′ _____ ″ _______ ″ _____ _______ D3 _____ ′ _____ ″ 4 P4 ___________ _____ ′ _____ ″ _______ ″ _____ _______ D4 _____ ′ _____ ″ 5 P5 ___________ _____ ′ _____ ″ _______ ″ _____ _______ D5 _____ ′ _____ ″ 6 P6 ___________ _____ ′ _____ ″ _______ ″ _____ _______ D6 _____ ′ _____ ″ 7 P7 ___________ _____ ′ _____ ″ _______ ″ _____ _______ D7 _____ ′ _____ ″ 8 P8 ___________ _____ ′ _____ ″ _______ ″ _____ _______ D8 _____ ′ _____ ″ 9 P9 ___________ _____ ′ _____ ″ _______ ″ _____ _______ D9 _____ ′ _____ ″ 10 P10 ___________ _____ ′ _____ ″ _______ ″ _____ _______
SIGNATURE OF APPLICANT: REGIONAL ENGINEER & BRIDGE ENGINEER
RECOMMENDATION
THIS PERMIT IS RECOMMENDED FOR APPROVAL, SUBJECT TO
SIGNATURE: ________________________________ THE PROVISIONS AND ATTACHMENTS INCLUDED HEREIN
TITLE: ______________________________________ SIGNATURE: ____________________________ DATE: __________
REGIONAL ENGINEER
DATE: _____________________ SIGNATURE: ____________________________ DATE: __________
BRIDGE ENGINEER
APPROVAL OF PERMIT
PERMISSION IS HEREBY GIVEN TO THE ABOVE APPLICANT FOR THE USE OF THE DESIGNATED ROADS AND BRIDGES IN THE MANNER DESCRIBED, SUBJECT TO THE PROVISIONS AND ATTACHMENTS INCLUDED WITH THIS PERMIT.
SIGNATURE: ____________________________________ DATE: _______________________
TITLE: FOREST SUPERVISOR _______________________________________________________
36CFR 261.10(a), 261.12 and 261.50
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