Docstoc

Ventura Wide Load Permit Application

Document Sample
Ventura Wide Load Permit Application Powered By Docstoc
					                                                        Street Use Permit for Heavy Transportation
                                                     & Construction Equipment in Compliance with the
                                                      House Moving, Nuisance, & Traffic Ordinances
IN COMPLIANCE WITH YOUR REQUEST AND SUBJECT TO ALL OF THE TERMS,
CONDITIONS AND RESTRICTIONS WRITTEN BELOW AND THE ATTACHMENTS,                                PERMIT VALID:             PERMIT NO.
PERMISSION IS HEREBY GRANTED TO:
                                                                                   (DATES)
TRANSPORTER
                                                                                   FROM: _____ / ______ / __________

ADDRESS                                                                            TO: ________ / ______ / __________

                                                                                   *NO MOVEMENT*
CITY/STATE                                                                         ❏		 BETWEEN 7 AM TO 9 AM
                                                                                       AND 4 PM TO 6 PM.

PHONE                                         FAX                                  ❏	 EXCEPT SAT, SUN, & HOLIDAY*
                                              NO.                                                                                  AUTHORIZED SIGNATURE
❏	 HAUL      LOAD OR EQUIPMENT AND MODEL NO.                                                                            FAXED OR COPIED PERMITS NOT VALID WITHOUT SEAL

❏	 DRIVE                                                                                                                ❏	ANNUAL PERMIT
                                                                                                                                                      STAFF INITIAL
❏	 TOW
TYPE VEHICLE


KING PIN TO                                          COMB. VEHICLE
LAST AXLE                                            LENGTH

                         LOADED DIMENSIONS DIFFERENT THAN OR WEIGHTS EXCEEDING THOSE SHOWN BELOW ARE NOT AUTHORIZED
LOADED MAX                         LOADED MAX                 LOADED MAX                               LOADED MAX                    WEIGHT
HEIGHT:                            WIDTH:                     OVERALL LENGTH:                          OVERHANG:                     CLASS

AXLE NUMBER             1                 2            3             4                    5                 6            7                        8                   9
NUMBER TIRES


AXLE SPACING


AXLE WIDTH


WEIGHT


ORIGIN                                                                           DESTINATION                             TRIPS


LOCATION AND/OR ROUTE:




IF A STRUCTURE IS BEING MOVED:
PRESENT ADDRESS OF BLDG.                                                           PROPOSED LOCATION
                                                                                                                                 (LOT, BLOCK, TRACT)
PILOT CAR       ❏	 FRONT 	❏	 REAR        ❏	 NONE REQUIRED
IN CONSIDERATION OF THE GRANTING OF THIS PERMIT, THE UNDERSIGNED DOES HEREBY AGREE TO:                                                       ATTACHMENTS
  1. CARRY ON OPERATION IN COMPLIANCE WITH CITY HOUSE MOVING, NUISANCE & TRAFFIC ORDINANCES
                                                                                                                             ❏	     PERMIT CONDITIONS
  2. HOLD HARMLESS THE CITY OF SAN BUENAVENTURA, AND THE EMPLOYEES OF THE CITY OF SAN BUENAVENTURA,
    FROM AND AGAINST ANY LIABILITY FOR INJURIES OR DAMAGES TO PERSONS OR PROPERTY ARISING FROM USE OF                        ❏	     PILOT CAR REQUIREMENTS
    PUBLIC STREETS AND WAYS.                                                                                                 ❏
  3. REIMBURSE THE CITY OF SAN BUENAVENTURA FOR DAMAGES TO STREETS OR OTHER CITY PROPERTY OR FOR
    ANY OTHER COSTS INCURRED BY THE CITY BY REASON OF THE APPLICANT'S OPERATIONS.                                            ❏

PURSUANT TO CALIFORNIA VEHICLE CODE, SECTION 35780, THIS PERMIT DOES NOT EXEMPT THE PERMITTEE FROM                           ❏
MEETING THE REQUIREMENTS SET FORTH BY THE CALIFORNIA DEPARTMENT OF TRANSPORTATION TO OPERATE
                                                                                                                             ❏
EXTRA-LEGAL LOADS WITHIN THE STATE RIGHT-OF-WAY

THIS ACKNOWLEDGES THAT THE REQUESTED ROUTE HAS BEEN REVIEWED BY THE APPLICANT FOR POTENTIAL
HAZARDS WITH RESPECT TO THE OPERATIONS TO BE UNDERTAKEN AND THAT NO IMPEDIMENTS HAVE BEEN FOUND.


❏	 CASH

                                        PERMITTEES AUTHORIZED AGENT NAME (PRINT)               PH#
❏	 CHARGE       FEE:$


❏	 EXEMPT
                                        PERMITTEES AUTHORIZED AGENT (SIGNATURE)                            DATE

               White Copy - Applicant                                    Yellow Copy - City Engineer                                         Pink Copy - Supt. Streets
                                                                                                                                     11 06
                                                                                                                                                 REV 10/06       FORM # 108

				
DOCUMENT INFO
Categories:
Tags:
Stats:
views:6
posted:10/30/2012
language:English
pages:1
PermitDocsPrivate PermitDocsPrivate http://
About