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228 WEST MAIN STREET, ROOM 19, GOLDENDALE WASHINGTON 98620 • FAX [PHONE REDACTED] • VOICE [PHONE REDACTED] 1 of K L I C K I T A T C O U N T Y P U B L I C W O R K S D E P A R T M E N T Permit Number: PWOS2021- For Use On KLICKITAT COUNTY ROADS Applying for: OVERWIDTH OVERLENGTH OVERWEIGHT Permission is herewith granted to: To transport: Width: Length: Weight: Over the following County Roads (list in order to destination): Road: Road: Road: Road: Road: For use on or between the following dates: Special Conditions: • If applicant is obtaining an Overweight permit, a copy of your Axle Report must be submitted with this permit request. • Should date change, please notify Klickitat County Public Works, [PHONE REDACTED] • Permit holder agrees to comply with the State vehicle laws governing use of special permits. • Any damage to County roads will be the responsibility of the permit holder. • Must comply with weather restricted conditions. Permit Holder Contact: Email: Telephone: Fax: Applicant Signature : Date: Permission granted by: Date: Public Works Director You are NOT guaranteed receive a signed permit within 24 hours of submitting your request Official Use Only Road Road Road Road Road SIGN