FLH Bridge oversized or overload vehicle permit request form April 2019.pdf
PDF 143 KB Posted
- Solicitation number
- 69056723R000003
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Text version
Revised 10/9/2018 Page 1 of 2
FLH BRIDGE OVERSIZED/OVERWEIGHT PERMIT LOAD REQUEST
APPLICATION DATE:
APPLICANTS NAME:
COMPANY NAME:
USDOT#:
PHONE NUMBER:
EMAIL ADDRESS:
DESCRIPTION OF LOAD:
DESCRIPTION OF ROUTE:
DATE OF MOVEMENT:
PERMIT VEHICLE CONFIGURATION
WIDTH: HEIGHT: LENGTH:
GROSS WEIGHT:
(COMPLETE VEHICLE CONFIGURATION SKETCH ON NEXT PAGE)
APPLICANTS SIGNATURE: DATE:
(AGENCY USE ONLY)
REVIEWED BY: DATE:
DENIED APPROVED
PERMIT CONDITIONS:
Revised 10/9/2018 Page 2 of 2
VEHICLE TOP VIEW
(w/ dimensions)
VEHICLE SIDE VIEW
(w/ dimensions)
Axle Number TOTAL Axle width (ft) WEIGHT (lbs) Load (lbs) per axle No. of Tires per axle
*Adjacent axles carrying the exact same load, dimensions and tires may be grouped in the axle table
A PERMIT SUBMITTED WITH INCOMPLETE, ILLEGIBLE, OR INCONSISTENT DATA WILL BE RETURNED FOR CORRECTION
| TOTAL WEIGHT lbsLoad lbs per axle: |
| Axle Number: |
| Axle width ft: |
| Load lbs per axle: |
| No of Tires per axle: |
| Axle Number2: |
| Axle Number3: |
| Axle Number6: |
| Axle Number7: |
| Axle Number8: |
| Axle width ft2: |
| Axle width ft3: |
| Axle width ft4: |
| Axle width ft5: |
| Axle width ft6: |
| Axle width ft7: |
| Axle Number4: |
| Axle Number5: |
| Axle Number5b: |
| Axle Number9: |
| Axle width ft8: |
| Axle width ft9: |
| Axle width ft10: |
| Load lbs per axle2: |
| No of Tires per axle2: |
| Load lbs per axle3: |
| No of Tires per axle3: |
| Load lbs per axle4: |
| No of Tires per axle4: |
| Load lbs per axle5: |
| No of Tires per axle5: |
| Load lbs per axle6: |
| No of Tires per axle6: |
| Load lbs per axle7: |
| No of Tires per axle7: |
| Load lbs per axle8: |
| No of Tires per axle8: |
| Load lbs per axle9: |
| No of Tires per axle9: |
| Load lbs per axle10: |
| Check Box1: Off |
| Permit Condition: |
| height: |
| length: |
| Date1: |
| Name: |
| Company name: |
| USDOT #: |
| Phone #: |
| Date3: |
| Date4: |
| Date2: |
| Route: |
| Load Description: |
| Email address: |
| Check Box2: Off |
| width: |
| GVW: |
| No of Tires per axle10: |
| Top view and side view truck: |
File details come from the government source that posted it. Updated .