Town of Shelburne Excess Weight Permit Application - SINGLE

Vermont Agency of Transportation
Department of Motor Vehicles

Single Vehicle ($5.00 fee)

Approval is hereby given for the granting of a permit under the provisions of VSA Title 23, Sec. 1400a, and any amendments thereto, covering the operation of motor vehicles over local highways and bridges with gross loads as follows:

* Owner:

* Street/P.O. Box

* City/Town

* State

* Zip Code

* Contact Person - Last Name

* Contact Person - First Name

Email Address

Fax Number

* Phone Number

INFORMATION ABOUT YOUR VEHICLE

* Type of Vehicle

If Other, List Here

* Number of Axles

* Year

* Model

* Registration Number

* VIN Number

* Product Carried

If Other, List Here

* Max Weight Requested

Town will fill in Maximum Weight Approved

* Date

For Department Use Only
Processor's Initials

* Indicates Response Required