DUBUQUE COUNTY ROAD DEPARTMENT SINGLE TRIP PERMIT (VALID FOR ONE POWER UNIT ONLY)

Issued by: Dubuque County Engineer's Office 1225 Seippel Rd Dubuque, IA 52002 563-557-7283 Permit No.

Fee: $35.00

Issued by: Dubuque County Engineer's Office 1225 Seippel Rd Dubuque, IA 52002 563-557-7283

Submit to: permits@dubuquecountyiowa.gov Fax 563-557-1973

Name Date Fax Number

Name
Date Submitted
Fax Number

Address City, State, Zip Check/Cash/Charge

Address
City, State, Zip

Power Unit Year & Make Power Unit License No. & State Power Unit Registered Weight Trailer Make Trailer License No. & State

Trailer Make
Power Unit Year & Make
Power Unit License No. & State
Power Unit Registered Weight
Trailer License No. & State
Interstate Travel Authority Number
Intrastate Travel Authority
US DOT Number
Object or Load
Model Number
VIN
Serial Number
SME Qualified
Width
Overall Length
He ght
Total Weight
Trailer Length
Load Length
Front
Rear Projections

Overall Length Width Height Total Weight Trailer Length Load Length Projections

Single
Tandem
Triple
Quad
Axle Spacing
Trip From:
Trip To:
Routes:

Front Rear

Axle Weights Single Tandem Triple Quad

Axle Spacing

Trip From: Trip To:

Routes:

GENERAL REQUIREMENTS: ☐ Civilian front escort ☐ Civilian rear escort ☐ Mounted height pole ☐ Overdimensional signs ☐ Amber revolving light/strobe light with 360circ visibility ☐ Required entire route ☐ Law enforcement escort front and rear ☐ Centerline all bridges: Primary at 5 mph, interstate at posted speeds ☐ Centerline all bridges: Primary at normal speed or travel in normal lane on bridges at 5 mph ☐ Load must slow or stop when necessary to avoid approaching traffic when centerlining ☐ Must carry copy of permit and current General Provisions and comply with them ☐ Road must be clear of ice and snow and visibility must be at least $ 1/4 $ mile ☐ Necessary state and/or city permits must be obtained separately ☐ Speed shall not exceed 45 mph on secondary road system. ☐ Vertical clearances are not guaranteed. Special Requirement: ____________________

Special Requirements

VALID DATES: ☐ 1/2 hour before sunrise to 1/2 hour after sunset ☐ 1/2 hour before sunrise to noon ☐ Continuous Dates: ____________________

Applicant Phone Number Dubuque County Permit Officer

Start date and upto 4 additional days = 5 days total
Email Address to return approved permit and invoice:
Applicant Name

Email Address to return approved permit and invoice: Permits available at https://dubuquecountyiowa.gov/203/Engineer-Roads

Email Address to return approved permit and invoice: