Terms and Conditions Agreement
Oversized Load Permit Application and Special Provisions
| Name of Applicant |
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| I agree to the terms and conditions of the Oversized Load Permit |
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Applicant Information
Contact Information
| Company Name |
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| Business Street Address |
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| City, State and Zipcode |
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| Office Phone Number |
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| Office Fax Number |
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| Email Address |
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| Date of Application |
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Load Information
| Load Type |
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| Description of the Load or Equipment and Model Number |
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Vehicle Information
| Description of Hauling Equipment |
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| Vehicle Width (Example: 12' 5") |
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| Semi-Trailer Length (Example: 45') |
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| Kingpin to Last Axle Length (Example: 40') |
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| Combination Vehicle Length (Example: 65') |
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| Maximum Allowable Weight (40,000 lbs) |
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Loading Vehicle Dimensions
| Loaded Height (Example: 14') |
14'
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| Loaded Width (Example: 10' 6") |
10'
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| Loaded Overall Length (Example 65' 10") |
65'
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| Loaded Overhang (Example: 1' 6") |
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| Weight Class |
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Tires per Axle
| Number of Tires on Axle 1 |
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| Number of Tires on Axle 2 |
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| Number of Tires on Axle 3 |
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| Number of Tires on Axle 4 |
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| Number of Tires on Axle 5 |
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| Number of Tires on Axle 6 |
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| Number of Tires on Axle 7 |
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| Number of Tires on Axle 8 |
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| Number of Tires on Axle 9 |
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Distance Between Axles
| Distance Between Axles 1 & 2 (Example: 8') |
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| Distance Between Axles 2 & 3 (Example: 8') |
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| Distance Between Axles 3 & 4 (Example: 8') |
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| Distance Between Axles 4 & 5 (Example: 8') |
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| Distance Between Axles 5 & 6 (Example: 8') |
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| Distance Between Axles 6 & 7 (Example: 8') |
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| Distance Between Axles 7 & 8 (Example: 8') |
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| Distance Between Axles 8 & 9 (Example: 8') |
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| Distance Between Axles 9 & 10 (Example: 8') |
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| Distance Between Axles 10 & 11 (Example: 8') |
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| Distance Between Axles 11 & 12 (Example: 8') |
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| Distance Between Axles 12 & 13 (Example: 8') |
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Width of Axles at Tire Sidewall
| Width of Axles at Tire Sidewall 1 (Example 8' 6") |
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| Width of Axles at Tire Sidewall 2 (Example 8' 6") |
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| Width of Axles at Tire Sidewall 3 (Example 8' 6") |
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| Width of Axles at Tire Sidewall 4 (Example 8' 6") |
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| Width of Axles at Tire Sidewall 5 (Example 8' 6") |
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| Width of Axles at Tire Sidewall 6 (Example 8' 6") |
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| Width of Axles at Tire Sidewall 7 (Example 8' 6") |
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| Width of Axles at Tire Sidewall 8 (Example 8' 6") |
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| Width of Axles at Tire Sidewall 9 (Example 8' 6") |
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| Width of Axles at Tire Sidewall 10 (Example 8' 6") |
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| Width of Axles at Tire Sidewall 11 (Example 8' 6") |
0
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| Width of Axles at Tire Sidewall 12 (Example 8' 6") |
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| Width of Axles at Tire Sidewall 13 (Example 8' 6") |
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Dates of Travel
| Inbound Date |
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| Is the Inbound Trip an Oversized Load? |
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| Outbound Date |
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| Is the Outbound Trip an Oversized Load? |
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Route Information
| Santa Monica Point of Origin (ex: Hwy @ Lincoln) |
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| Destination Address (Must be in Santa Monica) |
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| Route to Address |
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| Route from Address |
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Sign(s) Required
| Will Load Exceed 8'6" Wide or 65' Long? |
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Pilot Car(s)
| Will Load Exceed 10' Wide or 100' Long? |
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Certificate of Liability Insurance (COI)
| Upload COI |
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| Expiration Date of Insurance |
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Date and Time Permit Processed
Date and Time of Permit Final Review
| Date |
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| Time (e.g. 9:00 AM, NOON, 4:00 PM) |
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| Fee Collected |
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| Payment Type |
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| Permit Number (e.g. 19OLP-1004) |
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