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\"Image\"
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TO BE COMPLETED BY APPLICANT:
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Address:City/State/Zip:
Phone Number:Signature:
Trip from:\nTrip to:
Requested Route:
Dates Requested for Route Approval:
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"type": "FORM_FIELD", "location": { "l": 213.263, "t": 181.337, "r": 273.581, "b": 159.977 }, "text": "Axle Weights", "field_kind": "text", "label": "Axle Weights", "pdf_field_name": "Axle Weights 2", "pdf_field_type": "Text", "reading_order": 40 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 273.677, "t": 181.337, "r": 330.467, "b": 159.977 }, "text": "Axle Weights", "field_kind": "text", "label": "Axle Weights", "pdf_field_name": "Axle Weights 3", "pdf_field_type": "Text", "reading_order": 41 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 332.011, "t": 181.213, "r": 392.329, "b": 159.853 }, "text": "Axle Weights", "field_kind": "text", "label": "Axle Weights", "pdf_field_name": "Axle Weights 4", "pdf_field_type": "Text", "reading_order": 42 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 458.381, "t": 180.081, "r": 518.699, "b": 158.721 }, "text": "Axle Weights", "field_kind": "text", "label": "Axle Weights", "pdf_field_name": "Axle Weights 6", "pdf_field_type": "Text", "reading_order": 43 }, { "page": 1, "type": "TEXT", "location": { "l": 28.8, "t": 144.72, "r": 411.84, "b": 116.88 }, "text": "Valid Dates:", "reading_order": 44 }, { "page": 1, "type": "TEXT", "location": { "l": 28.56, "t": 114, "r": 577.68, "b": 81.24 }, "text": "Notes: Centerline all bridges at 5 mph, no shifting or braking.", "reading_order": 45 }, { "page": 1, "type": "TEXT", "location": { "l": 28.56, "t": 81.24, "r": 577.68, "b": 48.48 }, "text": "Approved By: ________________ Date: ________________", "reading_order": 46 }, { "page": 1, "type": "TEXT", "location": { "l": 25.92, "t": 41.52, "r": 577.44, "b": 15.12 }, "text": "This route is approved ONLY for the power unit, trailer/axel configuration, total weight and other vehicle configurations contained on this form for the valid dates shown. Any deviations from the route or vehicle configuration are fully at the risk of the applicant.", "reading_order": 47 } ] } ]