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NUMBER OF TIRES PER AXLE: AXLE NUMBER: COUNTY OF COLUSA DEPARTMENT OF PUBLIC WORKS 1215 MARKET STREET COLUSA, CALIFORNIA 95932 PHONE: (530) 458 - 0466 FAX: (530) 458 - 2035 [EMAIL REDACTED] www.countyofcolusa.com IN COMPLIANCE WITH YOUR REQUEST AND SUBJECT TO ALL THE TERMS, CONDITIONS AND RESTRICTIONS WRITTEN BELOW AND THE ACCOMPANIES, PERMISSION IS HERBY GRANTED TO: FROM: TO: PERMIT VALID: MOVEMENT AUTHORIZED: SATURDAY SUNDAY NO NIGHT TRAVEL Attachment PERMIT NUMBER: THIS PERMIT NOT VALID WITHOUT THE FOLLOWING ACCOMPANIMENTS: Permit Conditions DESCRIPTION OF HAULING EQUIPMENT: DIMENSIONS OF LOAD: DESCRIPTION OF THE LOAD OR EQUIPMENT AND MODEL NUMBER: HAUL DRIVE TOW OFFICE PHONE NUMBER (INCLUDING AREA CODE): OFFICE FAX NUMBER (INCLUDING AREA CODE): CITY: STATE: ZIP CODE: ADDRESS: NAME: VEHICLE WIDTH: SEMI-TRAILER LENGTH: KINGPIN TO LAST AXLE: COMBINED VEHICLE LENGTH: 1 2 3 4 5 6 7 8 9 WIDTH OF AXLES AT TIRE SIDEWALL: DISTANCE BETWEEN AXLES: MAXIMUM ALLOWABLE WEIGHT: NOT TO EXCEED THE LOADED DIMENSIONS SHOWN BELOW OR AXLE WEIGHTS SHOWN ABOVE LOADED HEIGHT: LOADED WIDTH: LOADED OVERALL LENGTH: LOADED OVERHANG: WEIGHT CLASS: ORIGIN: DESTINATION: YES NO PAYMENT: CHARGE CASH CHECK APPLICANT DATE: FEE: $15.00 $85.00 AUTHORIZED COUNTY Number of Trips: DATE: REQUESTED ROUTE: (Include Address of Origin and Delivery Site) CONTACT PERSON (Print): AUTHORIZED COUNTY ROADS/STREETS - STATE AND/OR CITY PERMITS AREREQUIRED WHENEVER THE * IS SHOWN. PILOT CAR: REVISED APRIL 10th, 2017