Company Company Name Email Phone Company Address Address Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Vehicle Information License # Motor or Serial # Year Make Oversize/Overweight Haul Oversize/Overweight Haul Expected Travel Time on County Roads # of Axles Gross Weight Distance 1st to Last Axle (ft/in) Max Height (ft/in) Width (ft/in) Length (ft/in) Date(s) of Transport Extraordinary Haul Action Extraordinary Haul Action Expected Travel Time on County Roads # of Axles Gross Weight Distance 1st to Last Axle (ft/in) Max Height (ft/in) Width (ft/in) Length (ft/in) Date(s) of Transport Are you moving weight in excess of 200,000 lbs? - None -YesNo Check all boxes that apply to the permit Mobilizing/Demobilizing Oil and Gas Drilling Rigs Other If Other, please explain: Repetitive Haul Repetitive Haul Gross Weight of Haul Over Entire Project Gross Weight of Vehicle Per Haul # of Axles Distance 1st to Last Axle (ft/in) Max Height (ft/in) Length (ft/in) Width (ft/in) Date of First Haul Projected Date of Last Haul Projected Number of Hauls Please state the nature of the proposed transport on Dolores County roads: Please state the proposed route(s) to be used for the transport: Required by Law The following restriction must be observed AS REQUIRED BY LAW: C.R.S. 42-4-101 TO 42-4-1717 (2C.C.R.601-4) Flagmen RequiredNumberWide Load Sign FrontWide Load Sign RearRed Flags Displayed on LoadPilot Car AheadPilot Car BehindMax. Speed Across Bridges, 10 M.P.H Be it understood by the applicant that this permit, when issued, is valid only on those highways under the jurisdiction of Dolores County and that to operate on highways under the jurisdiction of the State of Colorado or any Municipality herein, it is necessary to obtain a separate permit from the State and such Municipality. If the requested permit is granted, the applicant agrees: To take every precaution to protect the highway and the traffic from damage or injury, using pilot cars or flagmen to warn the traveling public on all blind curves, both vertical and horizontal. In case of over-width of load, the same to be placed on the vehicle with the overhangs as far to the right as possible and in any event the material shall be loaded so as to present the minimum hazard to traffic. To be financially responsible and to make prompt payment for any damage caused to the traffic, to traffic lights, overhead signs, wires, cables and other installations or to the highway or bridges by the transportation of loads. That the operator of the vehicle is duly licensed according to statute. To operate the vehicle or vehicles at all times in accordance with any and all provisions of law, except as exempted herein, with regard to motor vehicles and the operation thereof. Except when a permit is requested and granted for over-weight, the undersigned applicant specifically states that the load is legal weight; He/she certifies that he/she understands and accepts all provisions of this permit. THIS PERMIT NOT GOOD and becomes VOID during Blizzard, Heavy Snow, Dangerous Road Conditions, or Adverse Weather Limiting Sight Distance. This Application, when issued by Dolores County, becomes the requested permit subject to the above conditions and with the understanding that, no liability is assumed by the County by reason of its issuance, in regard to conditions of roads or capacity of bridges, and the applicant is charged to make necessary examination and inspection as to the adequacy of road and bridges to care for the traffic movement. In case of emergency, the field officials of the County have authority to suspend this permit until emergency conditions has passed. This Application and Permit is to be made out in duplicate, and both copies signed by both the Applicant and, if granted, by an Agent of Dolores County. The original is to be given to the Applicant; the second copy is to be retained by Dolores County. Every such permit shall be carried in the vehicle or combination of vehicles to which it refers and shall be open to inspection by any police officer or authorized agent of any authority granting such permit. Applicant and operators hereby consent to law enforcement stops for inspection purposes. Submit