Lynchburg Police Dept.

905 Court Street Lynchburg, VA 24504

REQUEST FOR PERMIT FOR OVERSIZED/ OVERWEIGHT VEHICLE

Applicant

Driver Phone Number

Company Name

Company Phone Number

Routing

Date(s) of Move:

Item(s) To Be Moved

Time(s)

Method

Haul

Drive

Tow

Origin

Destination

Routes of Travel

Vehicle

Transport Vehicle Make and Model

Transport Vehicle License Number

Trail License Number

Height (Include Feet and Inches)

Width (Include Feet and Inches)

Length (Include Feet and Inches)

Gross Weights (In Pounds)

Special Instructions

Police Escort Requested? If so, applicants must call (434) 455-6047 at least 24 hours in advance.

Yes

Please Upload a Copy of Your VA State Permit

Click Here to Upload

Signature of Applicant

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Traffic Safety Unit Use Only

Permit Number

Type

Single Trip

Blanket

Effective Date

Expiration Date

Authorized