P - 41183Engineering
Department
763-572-3551
763-571-1287 fax
LOAD LIMIT
MODIFICATION APPLICATION
C�ITY OF FRIDLEY
EFFECTNE 1/1/2010
APPLICATION DATE: `��_ /`�_
THIS APPLICANT IS: �HAULER
PROPERTY OWNER:___�%�`�'°.Ft-
JOB ADDRESS: �r �
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MATERIAL TO BE HAULED:_�
DATES TO BE HAULED (UP TO 3 DAYS):
YOUR E-MAIL
Permit No.: �� � �� � I
Received By:
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:
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 #O 1-2004 and State Statute Section 169.87
PERMIT MUST BE IN VEHICLE WHILE HAULING ON ESTABLISHED ROUTE.
NUMBER OF LOADS
$25 per load
PERMIT FEE $
THIS IS AN APPLICATION FOR A PERMIT-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 qrdin� es and cyodeslf�Ne City of Fridlpy. I understani this is not a permit but only an
application for a permit and hauling c�,tf re c ed ro�'s�y% start without a ermit.
SIGNATURE OF APPLICANT
APPROVED BY
COPIES GNEN TO: ❑ POLICE ❑ ENGINEERING
' NAMFJ 1''� / rIL
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City of Fridley
Engineering Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3551
FAX: 763-571-1287
DA
DATE
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