APPENDIX A: APPLICATION FOR SPECIAL VEHICLE USE PERMIT

Applicant(s): Vehicle Type and Description:

Owner(s): Permitted Driver(s) and License Nos.:

Insurance Co.:                                                            

Policy No.:                                                                

Agent:                                                                       

Telephone No.:                                                           

   I (We) acknowledge receiving a copy of § 70.03 of the City of Lakeland code and understand that any violation of the terms and provisions thereof may result in cancellation/revocation of the permit and impact any future applications I (we) may make.

Dated:                                                             By:                                                            

Dated:                                                             By:                                                            

Dated:                                                             By:                                                           

Dated:                                                             By:                                                            

   SPECIAL VEHICLE ROADWAY PERMIT

Permit No.:                                                       Issued:                                                        

   Expires:                                                        

   Pursuant to § 70.03 of the city code of ordinances, a Special Vehicle Use Permit is hereby issued to the Applicant listed above, for the vehicles listed above. All vehicle operations must comply with the provisions of § 70.03 as currently exists and as may be amended by the City of Lakeland.

   This Permit is non-transferable and non-assignable and terminates as of 12:01 a.m. on the date listed above.

   This Permit will terminate automatically should insurance coverage lapse or cease for any reason and shall terminate immediately upon a revocation notice being issued by the Office of the City Clerk.

   THE CITY OF LAKELAND

By:                                                               

   City Clerk

(Ord. 7475, passed 7-15-1997)

Click here to view the above application in a PDF document.