Virginia Blanket Hauling Permit Application
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1
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3VIRGINIA BLANKET HAULING PERMIT
HP 401 (12/17/2015)
APPLICATION
Telephone: (804) 786-2787 ● Fax: (804) 367-0063
Purpose:
Use this form to apply for a hauling permit covering multiple moves. See
DMV USE ONLY
RECEIVED DATE (mm/dd/yyyy)
REFERENCE NUMBER
additional instructions on page 3 of this application.
Instructions:
Mail or fax this form to the address or fax number above. Use the Virginia
CHECK NUMBER
CHECK AMOUNT
Hauling Permit Addendum Additional Axle (form HP 403) for configuration
exceeding 9 axles. Use the Locality Blanket Permit Addendum form HP
406 to order locality blanket permits.
REQUESTED DURATION (subject to approval)
REQUESTED EFFECTIVE DATE (mm/dd/yyyy) QUANTITY
_______ months
2 years
1 year
SHIPPER (Hauling or Transport Company)
ID NUMBER (VAHPS ID, FEIN, OR SSN)
GOVERNMENT MOVE (check one)
CONTACT PERSON NAME
Federal
State
COMPANY NAME
NAME (last)
(first)
(mi)
(suffix)
TELEPHONE NUMBER
(
)
MAILING ADDRESS
FAX NUMBER
(
)
P. O. BOX, SUITE NUMBER (if applicable)
EMAIL ADDRESS
CITY
STATE
ZIP CODE
VA JURISDICTION (county or city—VA only)
COUNTRY
COMMODITY AND VEHICLE
ITEM TO BE MOVED
CRANE MAKE AND MODEL (if applicable)
TRANSPORT METHOD (check one)
Drive
Haul
Tow
HAZARDOUS
VEHICLE ID LOCATION
LICENSE PLATE NUMBER
ISSUING STATE
VIN/SERIAL NUMBER (last 5 digits)
Yes
No
Straight Truck
Truck/Trailer Combination
OVERALL DIMENSIONS/SIDE OVERHANG
VEHICLE AND LOAD
SIDE OVERHANG
SELF-PROPELLED CRANE
Is the overhang evenly distributed across the left and right sides of the transporter?
HEIGHT
Width outside of left tire to outside of
feet
inches
Yes
None
No (must provide overhang width)
right tire.
WIDTH
WIDTH OVERHANG
feet
inches
LEFT ______ feet ______ inches
RIGHT ______ feet ______ inches
WIDTH _____ feet _____ inches
LENGTH
LENGTH OVERHANG
feet
inches
FRONT ______ feet ______ inches
REAR ______ feet ______ inches
AXLE WEIGHT AND SPACINGS
GROSS WEIGHT
LICENSED LEGAL WEIGHT
NUMBER OF AXLES
See instructions above for configurations exceeding 9 axles.
pounds
AXLE
1
2
3
4
5
6
7
8
9
WEIGHT
lbs
lbs
lbs
lbs
lbs
lbs
lbs
lbs
lbs
DISTANCE
(between axles)
feet
in
feet
in
feet
in
feet
in
feet
in
feet
in
feet
in
feet
in
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