Overweight/Overdimensional Proposed Route Survey
|NOTICE: |
|This form must accompany form TC95-10. |
|Please send to: |
|Fax: 502-564-0992 |
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|MAIL TO: |
|PO Box 2007, Frankfort KY 40602-2007 |
|Phone (502) 564-1257 |
|Drive. |
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|SECTION 1: APPLICANT INFORMATION |
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|HAULING COMPANY (applicant) |
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|USDOT# |
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|LOAD DESCRIPTION |
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|DATE OF SURVEY |
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|OVERALL LENGTH |
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|OVERALL WIDTH |
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|OVERALL HEIGHT |
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|HEIGHT OF POLE (6” above overall height) |
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|GROSS WEIGHT |
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|ORIGIN (complete address if in KY) |
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|DESTINATION (complete address if in KY) |
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|ROUTE |
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|SECTION 2: ROUTE DETAILS - For additional route details attach a separate sheet. |
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|The following must be considered while physically performing the survey. |
|All vertical/horizontal clearance must be checked at the highest/widest point of the load and lowest/narrowest of the area where the load will be traveling |
|insuring that all obstructions can be traveled under, over, or ramped safely |
|No obstruction can be moved or removed without written permission from the owner. |
|A manufacturer’s specification drawing must be attached. |
|Insure that the weight does not exceed any highway or bridge posted limit. |
|All loads over 200,000 lbs must attach a side & rear view drawing with axle spacing & weights. |
|Identify all locations where bucket trucks may be needed. |
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|ROUTE |
|(Name / Number) |
|DIRECTION |
|(N S E W) |
|LANE OF TRAVEL |
|(Right, Left, Center, Straddle) |
|NOTES: INCLUDE ALL OBSTRUCTIONS WITH MILE POINTS |
|(i.e. bridges, lights, wires, mast arms, trees, signs, poles, guardrail, railroad, owner of obstruction & contact information if applicable, etc.) |
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|SECTION 3: SIGNATURE |
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|The Surveyor does hereby certify that the proposed route as requested above has been physically checked for clearances related to the move being requested. |
|Furthermore, it is certified that the proposed load can safely clear every obstacle or bridge structures along the identified route. |
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|SURVEYING COMPANY NAME |
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|SURVEYOR’S NAME |
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|PHONE NUMBER |
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|SIGNATURE |
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|DATE |
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