Westminster Wide Load Permit Application by PermitDocsPrivate

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									                                                                                                                   FOR OFFICE USE ONLY
                                              City of Westminster
                                                     ENGINEERING DIVISION                                 PERMIT NO.
                                                      8200 Westminster Blvd
                                                      Westminster CA 92683
                                     TRANSPORTATION PERMIT—OVERSIZE LOAD                                     AUTHORIZED AGENCY REPRESENTATIVE

IN COMPLIANCE WITH YOUR REQUEST AND SUBJECT TO ALL OF THE TERMS, CONDITIONS AND RESTRICTIONS
WRITTEN BELOW AND THE ATTACHMENTS, PERMISSION IS HEREBY GRANTED TO:
                                                                                                              PERMIT VALID BETWEEN
 TRANSPORTER                                                                                                            AM
                                                                                                                        PM
 ADDRESS                                                                                                      AND SUNSET

                                                                                                            MOVING AUTHORIZED            YES     NO
 CITY/STATE
                                                                                                                        SATURDAY
 PHONE                                                                HCD. NO.                                           SUNDAY
                                                                                                              SUNSET TO SUNRISE
                          LOAD OR EQUIPMENT AND MODEL NO.
           HAUL


           DRIVE


           TOW

 TYPE VEHICLE


 KING PIN TO                                          COMB. VEHICLE                                        SENDING STATION           RECEIVING STATION
 LAST AXLE                                            LENGTH

               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

 ORIGIN                                                                                                   WEIGHT

 DESTINATION                                                                                              TRIPS


 AUTHORIZED ROADS/STREETS/HIGHWAYS           * - OTHER AGENCY PERMIT(S) REQUIRED




 PILOT CAR          YES              NONE REQUIRED
                                                                                                                              ATTACHMENTS

                                                                                                                             PERMIT CONDITIONS




       CASH

       CHARGE

       EXEMPT

 FEE       $                             PERMITEES AUTHORIZED AGENT (SIGNATURE)                    DATE

                                                                                                                                     4/21/2010

								
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