Scale Installation Permit Application - Mississippi Department Of Agriculture And Commerce

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STATE OF MISSISSIPPI
DEPARTMENT OF AGRICULTURE AND COMMERCE
P. O. Box 1609
Jackson, MS 39215-1609
No.
SCALE INSTALLATION PERMIT APPLICATION
The undersigned hereby applies for a permit to install a scale with a weight capacity of ten thousand (10,000) pounds or
more as required by Section 75-27-19, Mississippi Code of 1972, as amended.
Full Name of Applicant
Firm Name; if Corporation or partnership; give exact title
Mailing Address
Telephone No.
Company Street Address
County
Is the business owned by
an individual
partnership
corporation
cooperative.
Business or trade names used
Where filed
If corporation; which state
Date incorporated
Principal office in State of Mississippi
Installation Location -Company
Address
Weighing device (scale) information:
Manufacturer
Model
Capacity
Graduations
Serial Number
NTEP Certificate Number
Platform Size
Pit Type
Above Ground
Mechanical
Digital
Levertronic
Truck
Hopper
Other

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