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Engineering LQALI LIMIT �
Uepartment IYIC�DIF��ATIUI�T APFLI�A'TION' �'er�r��t t�to.�'. m 7
7b3-S?2-3 S S I • �,�y
CITY C?�' F�.2IDLE�' ��j �
�63-571-1287 f�x EF��cr�v��iino�o Da��C�"ec,ld/�
/�APLICAT[ON I�t1TE � "' � �7 ~� � �, Y(3UR �-MAIL
TIiIS APPLICANT IS: „OrHAULEtt ❑ t'ItQPER'fY OWtdER
I'f�UPERTX QWiVEIt: ,r-�
10E3 �UDRESS: y�. ��...� ` .,�, ,:
Iv�ATEl21AT, TO 13� FIAULEA: �
1�A1'ES T'U BE HAULEI3 {UP 3'O 3 DAYS); `"�
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'THIS PERIvIIT IS ISSLJ�D TQ ALLOW AN 1NCREASE OF AXLE WEIGHT FRf�M FO[3R (4) TONS PE�t
AXLE TO Ff VE (5j TONS F'ER AXLE �VER THE FOLLOWING DESIGNA►TED ItOUTE:
� �U S� r�h�
N4TICE: This p�rrnit is valid anly for veh'►cles enrc�ute ta cc7nstrucfiion address during the hours of 8:00 am to
S;QO pm. Se� Resalutiorr #U1-2a04 �nd State Statute Section 169.87
P�Ri4��T 1YtCTST BE IlY V'EHICLE WHILE HATII,II�G ON ESTABLISHED ROUTE.
NUMH�ER ()'� LOAI}S 1--
PER1I��IIIT FEE $
) 2.- e..'
per Coad
THiS I5 AiV APPGI+CATtON FCI!R A i'�RMIT-1�(OT Vr1i.iD i1N�'1L PRQC�SS�D
[ hereby epp�ty tbr a Ioad tarnit mQdi�cation permit and I ackncrwledgs tttat the information �bove is complete arcd accurate; that the
work wiil be in conformanc� wit% the o�inances and codos afth�e City of �ri�ftey, T understand this is not a�ermit but only an
application far a petmit and hauling Qn restricted roads is nat tn start without a per�a�it.
S[C3]#fATU1tE 4F pPPLICA T , � PRINT Nr�ME��t'��a �) I�c' DATE�; ,�I�
APPI�OVED BY �ATE ���/J / �
COPIES GI'VEN Tt7: I'QLI E❑ NfiINEERIAit3 /
�t�' O� FCit��4jr
Eng��,eering D�p�rtment
d�31 Univ�rsity Avenue NE, Fcitiiey, MN SS432
763-572•3551
�A3C; '76�-5�1-1287