P - 36919Engineering
Department
763-572-3551
763-571-1287 fax
.
LOAD LIMIT
MODIFICATION APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1/1/2010
Permit No.: Z � ��
Received B :
Dat'�`�R��d� �4� �
APPLICATION DATE: ZS �)!v J 1( YOUR E-MAIL ADDRESS: �����c S�Q �'f!r L,� 9,ti.,
THIS APPLICANT IS: ❑ HAULER ❑ PROPERTY OWNER
PROPERTY OWhTER: �R � s N (oV i3 So N
JOB ADDRESS: �� I I '3 2 D 5'7R F � 7 ,ti F
MATERIAL TO BE HALTLED: �!�- Pt ni �� LO !o L� A-Di=r2 /� e�c � iv S �� c. w�0 D w�} J� r �FF v F si,r�_
DATES TO BE HAULED (UP TO 3 DAYS): � 2
THIS PERMIT IS ISSUED TO ALLOW AN INCREASE OF AXLE WEIGHT FROM FOUR (4) TONS PER
AXEL TO FIVE (5) TONS PER AXEL OVER THE FOLLOWING DESIGNATED ROUTE:
.,�_ N a � ,�� fi� �
M� Q� C � �o � ��
? -e-�. i�t � [� N �
� 3
� �0 (�lo
ST �v�
fi o''�A �� S' 1✓� ( 60 �v
7�
NOTICE: This permit is valid only for vehicles enroute to construction address during the hours of 8:00 am to
5:00 pm. See Resolution #01-2004 and State Staxute Section 169.87
PERMIT MUST BE IN VEHICLE WHILE HAULING ON ESTABLISHED ROUTE.
= . `-t Lo-a d�3
NUMBER OF LOADS
$25 per load
FEE $ /Z �•`�
�,-- Ysu�t, r�. _ �T a.� `� �� �-1 U �-
THIS IS AN APPLICATION FOR A PERMTf-IYOT VALID UNTIL PROCESSED
I hereby apply for a load limit modification permit and I acknowledge that the information above is complete and accurate; that the
work will be in conformance with the ordinances and codes of the City of Fridley. I understand this is not permit but only an
application for a permit and hauling on restricted roads is no� o start without a permit.
SIGNATURE OF APPLICANT �e✓� �� �(L pRlriT NAME Dq� �/d /�
APPROVED BY _� DATE �lL G
COPIES GNEN TO: LI E iNEERiNG
�e�.� C� SSTt u�..� c�,�.
City of Fridley
Engineering Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3551
FAX: 763-571-1287
5911 3rd Street Northeast, Fridley, MN - Google Maps
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