Uniform County Permit

Single Trip Movement Approval Form


[FrontPage Save Results Component]

Fill out this form entirely, as all of the information is needed in order to process your request.

1. Please provide the following information:

Name of Owner
 
Company
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Unit No.
Make

License No. 

Lic. Wt.

Gr. Wt

Axle No

No.

No.

No.

No.

Axle Wts

Wts

Wts

Wts

  1. Enter the date of Move: -- mm/dd/yy

  2. Enter the time of  Move:

     

  3. Additional Information

     

    Move From:

    Move To:

    Via County Road(s):

    Description of Load:

    Width

    Height

    Length

    Townships Traveled In:

    Township Contacts

     

     

     

     

 


Copyright 2003 Burke County. All rights reserved.
Revised: 05/10/12