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PennDOT Home

M-936A (11-17). OVERSIZE/OVERWEIGHT PREVIOUS. APPLICATION FOR SPECIAL permit NO.: HAULING permit . ''ALL LINES (EXCEPT DASHES) MUST BE COMPLETED" APPLICATION ID: TYPE permit REQUESTED: Single Trip Single Trip & Return Annual Seasonal _____months Emergency Preliminary Superload Final Superload _____ of _____. permit OFFICE_____ NAME_____. REGISTERED NAME (Responsible Motor Carrier). ACCOUNT STREET_____. MOTOR CARRIER/ permit SERVICE ADDRESS. FEIN/SSN_____ CITY-STATE-ZIP CODE_____. IF NO MOTOR CARRIER ACCT. NO. 1 = IMMEDIATE PAYMENT. 3 = MONTHLY BILLING. BILL CODE_____ 4 = GOVERNMENTAL CHECK/MO # CHECK/MO #. permit FEE. <. GROSS WEIGHT_____ (lbs.) LEGAL WEIGHT = _____(lbs.) TOTAL LENGTH <. _____(ft.) _____ (in.). <. TOTAL WIDTH _____ (ft.) _____ (in.) =_____(ft.)_____ (in.). BODY WIDTH (63A/63B)__ <. TOTAL HEIGHT _____(ft.) _____ (in.)

PERMIT FEE: The Permit Fee will be determined at the time of issuance. The permit fee is the sum of the issuance fee and any ton-mile, escort or other established fees (e.g., $1 wire fee). See reverse of Form M-936A for the formula used to compute ton-mile fees.

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