Schedule “A” to By-law No. 557

The Municipality of the Township of Gillies

Application for a Permit/Permit to Exceed Posted Maximum Registered Gross Vehicle Weights

APPLICANT INFORMATION

Name of Applicant:

_________________________________________________

Roadways for Which a Permit is Requested:

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

Description of the Materials to be Hauled:

_______________________________________________________________

Estimated Total Volume/Weight of Materials to be Hauled:

_____________________________________________________

Source of Materials to be Hauled: ___________________________________

Destination of Materials to be Hauled: _______________________________

Number of Vehicles to be Utilized:__________________________________

Name of Owners/Operators of Vehicles to be Utilized  (including the applicant):

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

(attached a list if insufficient space is provided)

Approximate Maximum Loaded Weight per Vehicle: ________________________

Approximate Total Number of Vehicle (round )Trips: ________________________

Requested Commencement Date for the Permit :____________________________

Expected Completion Date of the Haul :_________________________________

In making this application I /we understand and accept that a permit will be subject to terms and conditions and we here by agree to comply with all such terms and conditions and to assume financial responsibility for any and all damages sustained by the roads or structures resulting from the activities for which a the permit would be issued.

Date: ______________   

Signature of the Applicant or the Applicant’s Agent:

_______________________________________