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DALLAS COUNTY ROAD DEPARTMENT OVERSIZE LOAD PERMIT (Valid For One Power Unit Only) Permit Issued By: Dallas County Road Department 415 River Street Adel, Iowa 50003 Send To DALLAS COUNTY ROAD DEPARTMENT Date Fax Number [PHONE REDACTED] Address 415 RIVER STREET, ADEL, IOWA 50003 Telephone Number [PHONE REDACTED] □ Single Trip $ □ Round Trip $ □ Annual Oversize$ □ Annual Oversize w/Weight $ Issued to Email Phone Number Address City/State/Zip Power Unit License No./State Power Unit Year/Make Registered Weight Trailer License No./State Trailer Make Object or Load Serial No. S.M.E. Plate No. Overall Length Width Height Total Weight Trailer Length Load Length Projections Front____ Rear Axle Weights Single Tandem Triple Quad Axle Spacing Trip From Trip To Routes Speed Limit - Max. posted limits unless otherwise specified on permit. Must carry copy of permit and General Provisions and comply with them. Road must be clear of ice and snow and visibility must be at least ¼ mile. Necessary city and/or state permits must be obtained separately Round Trip. Return by reverse route within same five days. GENERAL REQUIREMENTS: See General Provisions for escort requirements for overwidth vehicles Centerline all bridges: Constant 5 mph, no braking or shifting. Centerline all bridges: Centerline at normal speed or travel in normal lane on bridges a 5 mph, no braking/shifting Load must slow or stop when necessary to avoid approaching traffic when centerlining. Hazardous materials must be transported in compliance with applicable federal regulations Run around clearance on route # Run marked detour on route # ½ hour before sunrise to ½ hour after sunset Must comply with Road & Bridge Restriction Maps. Visit the Dallas County Permits/Policy page for current maps Special Requirements Valid Dates Requested By: Issued By: Disclosure statement: The information furnished on this application will be used by The Dallas County Road Department to prepare and issue permits. All information applicable to a given permit is required and is public information. Failure to complete the application as required will result in denial of permit. Permit issuing authorities will not be responsible for any damages that are the result of the move. The Dallas County Road Department and any other permit issuing assume no responsibility for the permit holder. Acceptance of Conditions: I certify that the statements contained in the application are true and correct and I will comply with the General Provisions of Iowa DOT Form 442052 in effect at the date of this signing.