P - 42191Engineering
Department
763-572-3551
763-571-1287 fax
APPLICATTON DATE:
THIS APPLICANT IS:
PROPERTY OWNER:
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JOB ADDRESS: ____���
MATERIAL TO BE HAULED:
LOAD LIMIT
MODIFICATION APPLICATION
C,ITY OF FRIDLEY
EFFECTIVE 1/I/2010
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LER ❑ PROPERTY OWNER
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DATES TO BE HAULED (UP TO 3 DAYS):
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Received By:�
Date Rec' d:
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:
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NOTICE: This permit is valid only far vehicles enroute to construction address during the hours of 8:00 am to
5:00 pm. See Resolution #O1-2004 and Sta.te Statute Section 169.$7
PERMIT MUST BE IN VEHICLE WHILE HAULING ON ESTABLISHED ROUTE.
NUMBER OF LOADS
$25 per load
PERMIT FEE $ �_f
THIS IS AN APPLICATION FOR A PERMTf-NOT 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 a permit but only an
application for a permit and haulin o stricte oads is not to start without a permit.
SIGNATURE OF APP AN PRINT NAIvIE /�((' (`% G%� ��G�p'TE / g' L�
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APPROVED BY DATE�'
COPIES GNEN TO � POLICE ❑ ENGINEERING
City of Fridley
Engineering Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3551
FAX: 763-571-1287