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227 W. IEFFERsoN BOULEVARD <br />SURE 1316 COUNTY -CRY BUILDING <br />SOUTH BEND, INDIANA 46601 <br />CITY OF SOUTH BEND <br />DEPARTMENT OF PUBLIC WORKS <br />PHONE 574/235-9251 <br />FAX 574/235-9171 <br />TDD 574/235-5567 <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 />QOversize 0 Overweight ❑ Hazardous Material ❑Superload <br />Submission Date: <br />3/25/24 <br />ApplicantName: <br />Zackary Hirt <br />Phone#:260-982-0302 <br />Faxs:260-982-7410 <br />Email: rack@worehousennovers.00nn <br />Application M <br />Route: <br />From: <br />211 W Marion St, South Bend, IN <br />To: <br />souiheasllot logletlalthe intersection otPatlagaAvaand WNava" 5l <br />Travel Date: <br />6/20/24 <br />❑Single Lane Occupancy Multi -Lane Occupancy <br />Time(s): <br />From: Sam <br />To: 10am <br />Contact` <br />Zackary Hirt <br />Phones 260-982-0302 <br />Load Description: <br />House on hydraulic dollies. <br />Length:60' FT IN Width: 40' FT IN Height: 37' FT IN <br />Vehicle Description: <br />Weight (Gross:) 200 too Max Weight (Single Axle): 25.000 Ibs <br />Number of Axles: t3 Axle Spacing: Rear Steerable Axle: QYes ❑No <br />Vehicle Type: ❑ Tractor -Trailer ❑ Truck -Trailer ❑ Truck 0 Other/rowed <br />Has the route been driven previously? <br />If so, provide the date. <br />Yes El No <br />Will the load be delivered within the City? <br />If so, consult Ordinance Section 21-07.05. for regulations. <br />X Yes ❑ No <br />Attach the following: ❑ Route Map 0 Axle configuration for vehicles over 5 axles <br />ror L-ounty route F <br />OFFICE USE ONLY: <br />❑ Approved <br />Comments: <br />contact: 5/4-Zj5-VbZb <br />❑ Approved as Noted <br />Engineering Division Authorized Signature: <br />IND01 route permit contact: 219-325-7523 <br />❑ Revise ❑ Revise as Noted <br />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: ❑ CreditCard ❑ Check ❑ Cash Vemon2.0[1/31/2022i <br />