WINNEBAGO COUNTY ROAD DEPARTMENT 126 South Clark Street
County Engineer’s Office Forest City, Iowa 50436
641.585.2905
engineer@winnebagocountyiowa.gov
Form WC-100
12-2015
Oversize/Overweight Load Permit Application No.____________
Permit Type/Fees
Single Trip ($35)
Round Trip ($70)
Annual Oversize ($50)
Multi Trip ($200)
Annual Oversize/Overweight ($400)
Alternative Energy Multi-trip ($600)
Route Approval (no charge)
Annual or All Systems Permit No.
Home Move Weight Increase
$
Increase Tons: Miles:
1
Fee: $35 + $.05 x A x B
A=Weight over registered weight (TN)
B=distance to be traveled under permit (miles)
Section A – Issued to:
Section B – Load (not required for Annual Oversize or Multi Trip Permit)
Describe Article(s) Transported:
SME Qualified?
Yes No
Model Number
Serial Number
Section C – Power Unit & Trailer Information
Power Unit – Both Plate/State and VIN must be identified
Plate:
State:
Vehicle Identification Number (VIN):
Registered Weight:
Year:
Make:
Trailer – Plate/State must be identified (not required for Annual Oversize, Multi Trip, or Annual Oversize/Overweight Permit)
Plate:
State:
Make:
Other (provide details):
Section D – Dimensions Weight
Overall Trailer Load Front Projection Rear Projection
Length
Width
Height
Gross Weight
Section E – Axle Weights/Spacing (Required for cranes and when gross weight is greater than 80,000 lbs.)
Axle Number
Gross Axle
Weight (lbs)
1 (front)
2
3
4
5
6
7
Axle Number
Gross Axle
Weight (lbs)
8
9
10
11
12
13
14
Axle Spacing
Section F – Trip (not required for Annual Oversize or Annual Oversize/Overweight Permit meeting Iowa code requirements)
Coming From:
Going to:
Route:
Special Requirements (office use):
_________________________________________________
_________________________________________________
_________________________________________________
Valid Dates: ______________________________________
Acceptance of Conditions: I certify that the statements contained in the application
are true and correct and I will comply with the General Provisions dated 07-2013.
X
(Customer or Authorized Agent) Date
Approval by Jurisdiction: Approved as modified and noted.
X
Winnebago County Engineer’s Office Date
Legal Name – Vehicle Owner or Lessee:
Requested Start Date:
Address:
Phone Number:
U.S. DOT Number:
City: State ZIP Code
FAX Number:
MC Number:
Email Address:
Carrier Type:
For Hire Private
Iowa Intrastate Authority Number:
Permit Delivery:
FAX Email Mail
Contact Name for questions / Area Code – Telephone No.
