Sign the printed copy and submit it to the Engineer's office at least 48 hours before the movement.
Pickaway County Engineer
Sterlin C. Mullins, P.E., P.S. · 121 West Franklin Street, Circleville, OH 43113 · Phone 740-474-3360 · Fax 740-477-1245
Submit this permit at least 48 hours prior to movement
Owner or Leasee of Vehicle
Application Date
Address
City
Zip Code
Person Requesting Permit (please print)
Email
Phone Number
Fax Number
Signature (sign after printing)
Load Description (including make and model or serial number)
Conveyence
This table scrolls sideways on a narrow screen.
Load Weight
Gross Weight
Front Overhang
Rear Overhang
Nine axle columns. This table scrolls sideways on a narrow screen.
From (Location, Municipality, State)
To (Location, Municipality, State)
Via Highways / Roads
Date Movement is to Begin
Date Movement will be Completed
Complete the axle detail table above only if the load is overweight.
Comments
Permit No.
Person Issuing Permit
Signature
Date
Nothing on this page is transmitted to the county. Print it, sign it, and deliver it as the form directs.