DATE:
Jeff Maiden, County Engineer
Form AC-1 - Revised 5/15/14
ATHENS COUNTY HAULING PERMIT
Athens County Engineer's Office
16000 Canaanville Road
Athens, Ohio 45701
Phone (740) 593-5514
Fax (740) 592-4616
COUNTY PERMIT NUMBER:
Permission is hereby requested by the following to transport the equipment and load described below:
TYPE PERMIT:
(Please type or print)
□
Trip (14 calendar days)
Name:
□
Trip & Return (14 calendar days)
Address:
□
90 Day Multiple Move
□
Annual (1 yr. from date granted)
Phone No:
Fax No:
□
Construction Equipment (12' legal)
E-mail
(optional):
□
Farm Equipment (14' legal)
(Application must be signed below in space provided.)
□
Manufactured Building
ALL WEIGHTS IN POUNDS
□
MAKE & MODEL
LICENSE NO.
STATE
WEIGHT EMPTY
Other
Truck or
THIS PERMIT IS VALID
Tractor
Beginning:
Ending:
*Semi-Trailer
All Dimensions Feet & Inches
Other Trailer
DIMENSIONS
(Jeep, Dolly)
Vehicle & Load Overall
Net Load
Description of Load including Make & Model, if applicable:
Length
Height
Width
Total Gross Weight
□
Check if applicable:
Load is towed on its own frame & carriage
Load Only
□
□
Load is under its own power
Variable trailers, see attached
Length
Height
Width
□
All weights (axle & gross are LEGAL in accordance with Section 5577.04 O.R.C.)
If checked, do not complete axle loads & spacing section of this application.
AXLE SPACING
AXLE LOADS
TIRES
MOVEMENT TO BE MADE
A
From
Axle No.
No. on Axle
Sizes
B
1.
C
2.
To:
D
3.
E
4.
Via Routes:
F
5.
G
6.
H
7.
I
8.
9.
10
Total Gross Weight
Limitations listed on back of Application Form AC-1 apply. Special provisions as checked
or listed below apply. Move only during daylight hours. Movement is prohibited Saturday,
Sunday or a holiday.
FOR OFFICE USE ONLY
VOID IF BLANK, ALTERED OR UNSIGNED
Permitee is responsible to check the route for abnormal, changed or unknown
conditions which may exist during any move.
PERMIT IS HEREBY:
I, __________________________________________ do hereby swear that I am
_____
Granted
_____
Denied
(Printed Name)
the applicant or his/their legally authorized representative and that the statements
_______________________________
made in the foregoing application are true and correct to the best of my knowledge.
By:
County Representative
SIGNATURE:
Date:
Time: