Yes No Yes No Single:
Yes No Yes No Double:
Yes No Yes No Triple:
Yes No Yes No Quad:
Yes No Yes No Total Weight:
Note: City's approval of this route is not a guarantee of it's availability, safety, or navigability.
REQUIREMENTS: These requirements must be reviewed by applicant and agree with State regulations when applicable.
Yes N/A Amber revolving light/strobe light with 360 degree visibility.
Yes N/A Front Rear
Yes N/A Law enforcement escort
Yes N/A SME Plate must be displayed when applicable.
Yes N/A Over dimensional signs and flags must be displayed.
Yes N/A Load must slow or stop when necessary to avoid approaching traffic when centering.
Yes N/A Round trip - return within valid dates below.
Will route cross over any City bridges? If yes, list the location(s).
Yes No Will route cross under any City bridges? If yes, list the location(s).
Applicant (Print): Date:
Signature: CC: Auth _____________________
City Official (Print):
The State will allow this load on the Interstate per the conditions stated on this permit.
Requested route through the City limits:
Power Unit: License No. & State:
Power Unit: License Class:
Trailer License No. & State:
Axle weights/Varied axle weight
INFORMATION: Are variance(s) requested? If yes, applicant must provide the variance as well as the statutory limit.
CITY OF COUNCIL BLUFFS, IOWA
Permit accuracy, information, and requirements provided are the responsibility of the applicant and/or driver, and must be in accordance with the Iowa Department of Transportation permit
regulations, Iowa Administrative Code. Permit issuing authorities will not be responsible for any damages that are a result of the move. This document must be accompanied by an Iowa Department
of Transportation permit if entering or exiting the City on a Federal or State Roadway.
LENGTH - WIDTH - HEIGHT - WEIGHT
5.) Necessary State and/or County permits must be obtained separately............STATE PERMIT NUMBER:
2.) Travel from sunrise to sunset.
1.) Must carry copy of permit.
3.) Hazardous materials must be transported in compliance with applicable Federal regulations.
4.) Road must be clear of ice and snow with visibility of at least 1/4 mile.
6.) Special requirements:
7.) Permit to be filed 24 hours prior to hauling loads.