VILLAGE OF WINTHROP HARBOR
830 Sheridan Road
Winthrop Harbor, IL 60096
(847) 872-3846
OVERSIZE/WEIGHT VEHICLE PERMIT APPLICATION
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Account No. Date
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Permittee (owner or lessee of vehicle)
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Applicant's Name or Work Order (optional) Type of Permit
Applicant's Address ______ Single Trip
______ Round Trip
______ Multiple Routing
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Power Unit Description License No.
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Description of Object or Vehicle to be Moved
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Number of Axles Gross Weight Axle Weights (beginning with steer axle)
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Width Length Height From
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Routes
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To (specify destination)
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(Do Not Write Below This Line - For Village Use Only)
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Date Permit Number Authorized Movement as Described Above with the Following
Exceptions/Conditions
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Gross Weight Axle Weights Front Tandem (or axle) _________________ No. Axle
Exceeds______________
_____Legal or Rear Tandem (or axle) ________________ No. Axle Exceeds______________
2002 S-11
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Width Length Height From
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To Effective Expires Fee
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Permit Must Comply with General Provisions on back and Special Provision Numbers
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FOR POLICE USE ONLY Ext. No. Effective Expires
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For verification of permit, call one of the above numbers.
This permit must be carried in the vehicle and must be available for inspection by police or Village officials.
If it is found that this permit does not cover the move, the permittee must contact the Village and have the permit corrected prior to starting the move.
Check by: ofc. __________________________________
Agency: ________________________________________
Date: ___________________________________________
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AUTHORIZED SIGNATURE