HomeMy WebLinkAboutMoving_Permit_Application_(Fillable)
Department of Public Works NO.
County of Hawai‘i
Hilo, Hawai‘i DATE:
Phone: (808) 961-8321
Fax: (808) 961-8630 STATE PERMIT NO.
In compliance with Section 291-36, Hawai‘i Revised Statutes, permission to move heavy vehicles
and/or objects exceeding the height, width and length specified in Sections 291-34 and 35, Hawai‘i Revised
Statutes.
Overall dimensions and weight of loaded vehicle:
Height: Feet Inches Length: Feet Inches
Weight: Lbs. Width: Feet Inches
Type of Object or Equipment
Route of Travel: Origin
Destination
Over Routes:
Time of Movement: Date
Time: From To
The undersigned applicant agrees to assume full responsibility for any loss or damages to County
bridges, roads, life and/or property from such operation or moving and shall indemnify and hold harmless the
County of Hawai‘i and its officers or employees from any suits or claims. The Police Department shall be
notified of the route and time of each movement; also the Police Department’s approval shall be obtained prior
to such movement, otherwise this permit will be considered void.
FIRM PHONE: FIRM:
FIRM FAX: BY:
(Electronic signature accepted)
FIRM EMAIL:
Additional Conditions (for DPW use only):
1) Escorts: Police Front
Private Rear
2) Check Vertical Clearance (vehicles over 14’-0” in height)
3) Maintain temporary bridge reinforcement at mile post 51, Saddle Road.
for Director
cc: Applicant
Hawai‘i Police Dept. (Fax: 961-2228)
DPW Form 11
Revised 06/04/12
County of Hawai‘i is an Equal Opportunity Provider and Employer.