Permit No
-152400000Secondary Roads DepartmentAPPLICATION FOR 19501 HWY 64, P.O. Box 368ROUND TRIP PERMITAnamosa, IA 52205Telephone: (319) 462-3785 Application No.:T- Email: engineer@co.jones.ia.usApplication Fee:$70.00 APPLICANT INFORMATION (PLEASE PRINT CLEARLY OR TYPE)Vehicle Owner or Lessee: Requested Start Date: Mailing Address: (Street Address)(City)(State)(Zip)Phone Number: Email Address: LOAD INFORMATIONDescribe Article(s) Transported: Model Number: Serial Number: POWER UNIT & TRAILER INFORMATIONPower UnitPlateStateVehicle Identification Number (VIN)Registered WeightYearMake TrailerPlateStateMakeOther (provide details) DIMENSIONS/WEIGHTOverallTrailerLoadFront ProjectionRear ProjectionLength Width Height Gross Weight AXLE WEIGHTS/SPACINGSAxle Number1 (front)234567Gross Axle Weight (lbs)Axle Spacing Axle Number891011121314Gross Axle Weight (lbs)Axle Spacing TRIP INFORMATIONComing From: Going To: Route: Applicant Signature:Approved By:(Customer or Authorized Agent)DateJones County Engineer’s OfficeDate ................
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