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Desired Effective Date: Vehicle License No. : Route of Move: From: Anticipated Number of trips: Freight or Commodity to be hauled: Allowable Legal Gross Vehicle Weight: Description of Truck (i.e. axle configuration): Allowable Gross Vehicle Weight: Special Conditions, Route to be used, or Terms: Permit Effective Date: Permit Expiration Date: Applicant Signature Date Date This permit is valid only for the weight and/or load size stipulated in this permit. This permit is valid only for the time and date stipulated in this permit. This permit is valid only for the to and from trips stipulated in this permit. This permit is valid only for the vehicle listed on this permit or attached list if more than one. This permit is valid only for the route designated in this permit. Any violations of the requirements stated on this permit will be cause for immediate revocation of said permit. Phone (715) 374-2575, Fax (715) 374-2495 or e-mail: [EMAIL REDACTED] (Permit Required for Each Power Unit and Must be Carried in the Truck Cab) DOUGLAS COUNTY HIGHWAY DEPARTMENT Single Trip Permit Application General Moving Permits for Overweight or Oversize Equipment or Loads, etc… Insurance Company Name: Fax No.: City, State, Zip: (N/A if unknown) Desired Expiration Date: permit, and if granted a permit, I will comply with the terms and conditions which apply. Douglas County assumes Return this completed form by mail, fax or email to the Douglas County Highway Department, P.O. Box 174, Hawthorne, WI 54842 The Single Trip Permit is Vailid from the Effective Date to the Expiration Date no liability for incorrect or false information provided on this application by the permitee. County Representative Signature Telephone No. : Applicant Name: Address: City, State, Zip: Address: Douglas County Highway use only To: Acceptance of Conditions: I, the applicant, have read and fully understand the requirements and conditions of this Last Updated On: 5/12/2011 Print Form Submit by Email