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227 W. JEFFERSON BOULEVARD PHONE 574/ 235-9251 <br />SUITE 1316 COUNTY-CITY BUILDING FAX 574/ 235-9171 <br />SOUTH BEND, INDIANA 46601 TDD 574/ 235-5567 <br />CITY OF SOUTH BEND <br />DEPARTMENT OF PUBLIC WORKS <br />SPECIAL TRUCKING PERMIT <br />*FAX OR MAIL FORM 3 WORKING DAYS (EXCLUDES WEEKENDS) BEFORE REQUIRED 48 HR PUBLIC NOTICE <br />**48 HR PUBLIC NOTICE ANNOUNCED UPON APPROVED FORM <br />***THIS APPLICATION EXPIRES 30 DAYS FROM SUBMISSION DATE <br />Oversize Overweight Hazardous Material <br />Submission Date: <br />Applicant Name: Phone #: Fax #: <br />Email: <br />Application #: <br />Route: From: To: <br />Travel Date: Single Lane Occupancy Multi-Lane Occupancy <br />Time(s): From: To: <br />Contact: Phone # <br />Load Description: <br />Vehicle Description: <br />Length: Width: Height: <br />Weight (Gross:) Max Weight (Single Axle): <br />Number of Axles: Axle Spacing: Rear Steerable Axle: Yes No <br />Vehicle Type: Tractor-Trailer Truck-Trailer Truck Other/Towed <br />Has the route been driven previously? <br />If so, provide the date. Yes No <br />Will the load be delivered within the City? <br />If so, consult Ordinance Section 21-07.05. for regulations. Yes No <br />Attach the following: Route Map Axle configuration for vehicles over 5 axles <br />For County route permit contact: 574-235-9626 For INDOT route permit contact: 219-325-7523 <br />OFFICE USE ONLY: <br />Approved Approved as Noted Revise Revise as Noted <br />Comments: <br />Engineering Division Authorized Signature:Date: <br />Oversize/Overweight/Hazardous permits requires a non-refundable payment of $35 made payable to the City of South Bend <br />Superload permits requires a non-refundable payment of $50 made payable to the City of South Bend <br />Payment Method: Credit Card Check Cash <br />Superload <br />Version 2.0 [1/31/2022] <br />x x <br />Wolfe House Movers of IN LLC.260-224-2615 260-982-7410 <br />andrew@wolfehousemovers.com <br />1006 St. Vincent St, <br />South Bend, IN <br />1105 N Foster St, <br />South Bend, IN <br />x <br />8:00 AM 2:00 PM <br />Andrew Heck 260-224-2615 <br />House on hydraulic dollies. <br />150,000 lbs 25,000 lbs <br />6 x <br />x <br />x <br />31'38'36'+ <br />will barricade route using combination of type III barricades <br />and off-duty police officers/vehicles <br />-13-