AnaheimTransportation Permit Application by PermitDocsPrivate

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									IN COMPLIANCE WITH YOUR REQUEST AND SUBJECT TO ALL OF THE TERMS, CONDITIONS                         CITY OF ANAHEIM
AND RESTRICTIONS WRITTEN BELOW AND THE ATTACHMENTS, PERMISSION IS GRANTED TO:
TRANSPORTER                                                    PHONE (TRANSPORTER)
                                                                                                    PUBLIC WORKS DEPARTMENT
                                                                                                    200 S. Anaheim Blvd., Suite 276
ADDRESS                                                                                             Anaheim, California 92805
                                                                                                    Phone: (714) 765-5183 Fax: (714) 765-5225

                                                                                                     TRANSPORTATION PERMIT
CITY/STATE




                                                                                                    No. ______________________
PERMIT AGENT, IF APPLICABLE                                       PHONE (AGENT)



                      LOAD OR EQUIPMENT AND MODEL NO.
         HAUL
                                                                                                                              SINGLE TRIP
         DRIVE
                                                                                                                              SINGLE TRIP & RETURN
         TOW
                                                                                                                              MULTIPLE TRIPS
TYPE VEHICLE                                                                                   KING PIN
                                                                                               LAST AXLE                      AMOUNT $
                LOADED DIMENSIONS DIFFERENT THAN OR WEIGHTS EXCEEDING THOSE SHOWN BELOW ARE NOT AUTHORIZED
MAX                                       MAX                                        MAX                                      MAX
HEIGHT:                                   WIDTH:                                     OVERALL LENGTH:                          OVERHANG:
         AXLE NUMBER                     1              2            3              4               5               6        7             8               9
         NUMBER TIRES

         AXLE SPACING

       AXLE WIDTH

WEIGHT


ORIGIN (ANAHEIM)                                                                     DESTINATION (ANAHEIM)


AUTHORIZED ROADS/STREETS/HIGHWAYS      NOTE: STATE PERMIT REQUIRED FOR ROUTE(S) OVER AND/OR UNDER STATE BRIDGES.




SPECIAL CONDITIONS:




ACCEPTANCE OF THIS PERMIT CONSTITUTES AN AGREEMENT BY THE PERMITTEE TO OBSERVE AND COMPLY WITH ALL OF        PERMIT VALID BETWEEN
THE GENERAL AND SPECIFIC CONDITIONS ON THE FACE OF THE PERMIT AND ATTACHMENTS HERETO AND THAT
PERMITTEE HAS RECEIVED/READ A COPY OF THE PERMIT CONDITIONS.                                                                           /
                                                                                                      DATE: _________ _________ __________       /
                                                                                                                        DATE: _________/_________/__________
PERMITTEE'S AUTHORIZED AGENT SIGNATURE                                                            DATE                    MOVING AUTHORIZED          YES       NO
                                                                                                                          12:01 AM TO 11:59 PM
                                                                                                                          9:00 AM TO 3:00 PM
PRINT NAME                                                                        PERMIT COMPANY (IF APPLICABLE)          6:00 PM TO 6:00 AM
                                                                                                                          SATURDAY/SUNDAY
APPROVED:
                      CITY AUTHORIZED REPRESENTATIVE                                    DATE                 TIME       OTHER: ______________________________
RESTRICTED HOURS APPLY FOR WIDTH >10 FT AND/OR PILOT CAR REQUIRED.                                                                             1       2       NO
                                                                                                                          PILOT CAR(S)
ONE (1) PILOT CAR REQUIRED FOR WIDTH >12 FT TO 14.5 FT AND/OR LENGTH 75 FT TO 100 FT.
                                                                                                                          REQUIRED
TWO (2) PILOT CARS REQUIRED FOR WIDTH >14.5 FT AND/OR LENGTH >100 FT.        PAYMENT CONFIRMATION
CONTACT POLICE DISPATCH FOR LENGTH >100 FT AND/OR WIDTH >15 FT.                                                           CONTACT POLICE             YES       NO
                                                                                                                          DISPATCHER PRIOR TO
DISTRIBUTION: PERMITTEE, ENGINEERING REP., POLICE DEPT-TRAFFIC DIV.                                                       MOVE AT (714) 765-1900
                                                                                                                                     TRAFFIC ENG - 133 REVISED 3/11

								
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