OVERWEIGHT / OVERSIZE E IT APPLICATION

1 State ICC-MC DOT Towed Loaded Self-Propelled Various TrailersVehiclesEmpty of AxlesSizesLengthWidthHeightPower-UnitPow er UnitTrailerTrailerOther TrailerLoadOverhangOverall123456789 COMPLETE IF OVERWEIGHTS pacing Between AxlesTire WidthNumber of Tires on AxleAxle WeightAxle NumberEngineer's Office Comments:ROUTING INFORMATIONTo: (Intersection or Address)From: (Intersection or Address)VIA Highways / RoadsPlate No. and StateMakeApplicant Name - Owning Company or Contractor OVERWEIGHT / OVERSIZE VEHICLE PERMIT APPLICATION & PERMITLoad - Description (include make and model or serial number) APPLICATION DateAddressZipCityFax NumberContact PersonLoad WeightTotal Gross WeightSANDUSKY COUNTYENGINEER'S OFFICE2500 WEST STATE STREET, FREMONT, OHIO 43420 Phone: (419) 334-9731 FAX: (419) 334-9733 Type of Permit Requested: (Check All Applicable)Duration of Permit: Desired Effective Date: _____ 5 days90 Days365 daysOverwidth Overheight Overlength Trip & Return Other Fee (See Notes Below) Credit Card Other Office Use Only: OVERWEIGHT A copy of this permit shall be in the possession of the driver at all times and shall be shown on demand to any law enforcement officer.

2 Single Trip Police Escort Total Permit Fee = $Paid by: Cash Check #_____ Load + Empty Weights= All Weights Legal Construction Equipment (12' wide or less & All Weights Legal) Other Permit Type _____(Use "Type Permit" as listed on ODOT Permit) _____N/AContinued on Page 2 Address:Phone:By signing below, I agree that I have read and accept all of the above Terms & Conditions, and I verify that the information being submitted is true and exact, without exception. Acceptance of this permit shall be deemed acceptance of the Terms & Conditions specified :Date:Official Use OnlyIssuance Date: Effective Date: Expiration Date:Permit No.:Permit Type:Official Use OnlyFor Sandusky Co. Engineer's office if blank, altered, or unsigned.(In lieu of signature, type name of duly authorized individual that is requesting permit on behalf of "Applicant" as listed above)Email completed " APPLICATION " to: orFax completed " APPLICATION " to: 740-539-8819 ALL Hauling Permit requests for Sandusky County and Township roadways are processed by Integrity Permits, LLC Please contact Integrity Permits at 740-994-1844 or 740-994-1845 with any questions"LIMITATIONS/PROVISIONS ON THE USE OF A REGIONAL HAULING PERMIT" Must accompany this permitTERMS & CONDITIONSP ursuant to Section of the Ohio Revised Code, the below-named permittee is hereby authorized to move the vehicles, objects or structures identified herein that are in excess of the weight and/or size maximums specified in sections to of the Revised Code, or otherwise not in conformity with sections to of the Revised Code.

3 Movement is authorized upon the specific streets, highways, bridges or culverts identified herein and the permittee shall be limited to those routes specified and no others. Authorization to traverse bridges/structures owned and/or maintained by entities other than the Sandusky County Commissioners or Township Trustees (in the case of a Township owned/maintained roadway) must be obtained from the proper authorities ( State owned roadways, City or Village roadways and the Ohio Turnpike).-- Maximum Permitted Speed May Not Exceed 45 MPH. --This permit may be suspended or revoked by the Sandusky County Engineer or any law enforcement officer for any good cause, including, but not limited to, any violation of the terms, conditions and limitations of this permit, any violation of law, or any lapse or reduction of the required insurance coverages. This permit shall take effect on the _____ day of _____, 20_____, and shall expire on the _____ day of _____, 20_____ (or the date of expiration of the required insurance, whichever is earlier; or, in the case of a single move, upon completion of the move).

4 This permit is subject to all Terms, Conditions and Limitations contained herein. All limitations/provision and special conditions required as part of an ODOT permit issued for the permitted vehicle/load specified in this permit shall be considered requirements of this Notes / Terms & Conditions of this Permit:_____Name of Permittee/Applicant.