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YES NO 1 2 NO YES NO CONTACT POLICE DISPATCH FOR LENGTH >100 FT AND/OR WIDTH >15 FT. DISTRIBUTION: PERMITTEE, ENGINEERING REP., POLICE DEPT-TRAFFIC DIV. TRAFFIC ENG - 133 REVISED 3/11 ONE PILOT CAR REQUIRED FOR WIDTH >12 FT TO 14.5 FT AND/OR LENGTH 75 FT TO 100 FT. CITY OF ANAHEIM PUBLIC WORKS DEPARTMENT 200 S. Anaheim Blvd., Suite 276 Anaheim, California 92805 Phone: (714) 765-5183 Fax: (714) 765-5225 CONTACT POLICE DISPATCHER PRIOR TO MOVE AT (714) 765-1900 RESTRICTED HOURS APPLY FOR WIDTH >10 FT AND/OR PILOT CAR REQUIRED. TWO PILOT CARS REQUIRED FOR WIDTH >14.5 FT AND/OR LENGTH >100 FT. PAYMENT CONFIRMATION MOVING AUTHORIZED 12:01 AM TO 11:59 PM 9:00 AM TO 3:00 PM 6:00 PM TO 6:00 AM SATURDAY/SUNDAY OTHER: PILOT CAR(S) REQUIRED CITY AUTHORIZED REPRESENTATIVE DATE TIME PRINT NAME PERMIT COMPANY (IF APPLICABLE) APPROVED: MAX HEIGHT: MAX WIDTH: MAX OVERALL LENGTH: AXLE NUMBER MAX OVERHANG: AXLE SPACING AXLE WIDTH NUMBER TIRES 4 6 5 7 TYPE VEHICLE KING PIN LAST AXLE LOADED DIMENSIONS DIFFERENT THAN OR WEIGHTS EXCEEDING THOSE SHOWN BELOW ARE NOT AUTHORIZED 9 8 HAUL DRIVE TOW LOAD OR EQUIPMENT AND MODEL NO. TRANSPORTATION PERMIT No. IN COMPLIANCE WITH YOUR REQUEST AND SUBJECT TO ALL OF THE TERMS, CONDITIONS AND RESTRICTIONS WRITTEN BELOW AND THE ATTACHMENTS, PERMISSION IS GRANTED TO: PHONE (TRANSPORTER) TRANSPORTER ADDRESS CITY/STATE PHONE (AGENT) PERMIT AGENT, IF APPLICABLE WEIGHT ORIGIN (ANAHEIM) DESTINATION (ANAHEIM) 1 2 3 DATE AUTHORIZED ROADS/STREETS/HIGHWAYS NOTE: STATE PERMIT REQUIRED FOR ROUTE(S) OVER AND/OR UNDER STATE BRIDGES. PERMIT VALID BETWEEN ACCEPTANCE OF THIS PERMIT CONSTITUTES AN AGREEMENT BY THE PERMITTEE TO OBSERVE AND COMPLY WITH ALL OF 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. SINGLE TRIP SINGLE TRIP & RETURN MULTIPLE TRIPS AMOUNT $ SPECIAL CONDITIONS: DATE: DATE: PERMITTEE'S AUTHORIZED AGENT SIGNATURE