Request For Designated Routes Up To 129,000 Pounds ITD 4886 (Rev. 03-14) Idaho Transportation Department itd.idaho.gov This form is designed to be completed electronically. If completing manually and additional space is needed, continue the narrative on the reverse side. Correspond the number of the section on the front with the continuation on the reverse. Company Name Name Contact Person’s Contact Phone Number Fax Number E-Mail Address Company Address City State Zip Code State Highway Route(s) Requested Vehicles operating on the requested routes cannot exceed the maximum overall length or off-track as shown on the Extra Length Map at . Submit a map with requested route(s) along with this completed form. Highway Number Beginning Milepost Ending Milepost Highway Number Beginning Milepost Ending Milepost Local Route(s) Requested Roadway Name(s) Beginning Milepost Ending Milepost Jurisdiction Name Date Request Sent Reasons for Request - Continue on reverse side if necessary, corresponding the number of the section with the continuation. 1. Justification 2. Associated Economic Benefits 3. Approximate Number of Trips Annually 4. Commodities Being Transported 5. Anticipated Start Date to Use Requested Routes Name Signature Date Requestor’s Printed Requestor’s Requestor is required to submit a completed application to ITD (see below) and to city, county, and/or highway district officials where the requested state route (or state route segment) is contiguous to respective jurisdiction(s). Idaho Transportation Department Fax: (208) 334-8195 Attn: Chief Engineer or PO Box 7129 Email: Boise ID 83707-1129 ITD Use Only Proceed Reject Date Hwy Review D-1 D-2 D-3 D-4 D-5 D-6 Proceed Reject Date Proceed Reject Date Proceed Reject Date Bridge Chief Review Engineer Cc: Local Highway Technical Assistance Council (LHTAC)
Request For Designated Routes Up To 129,000 Pounds ITD 4886 (Rev. 03-14) Idaho Transportation Department itd.idaho.gov This form is designed to be completed electronically. If completing manually and additional space is needed, continue the narrative on the reverse side. Correspond the number of the section on the front with the continuation on the reverse. Company Name Contact Person’s Name Contact Phone Number Fax Number E-Mail Address Company Address City State Zip Code State Highway Route(s) Requested Vehicles operating on the requested routes cannot exceed the maximum overall length or off-track as shown on the Extra Length Map at . Submit a map with requested route(s) along with this completed form. Highway Number Beginning Milepost Ending Milepost Highway Number Beginning Milepost Ending Milepost Local Route(s) Requested Roadway Name(s) Beginning Milepost Ending Milepost Jurisdiction Name Date Request Sent Reasons for Request - Continue on reverse side if necessary, corresponding the number of the section with the continuation. 1. Justification 2. Associated Economic Benefits 3. Approximate Number of Trips Annually 4. Commodities Being Transported 5. Anticipated Start Date to Use Requested Routes Requestor’s Printed Name Requestor’s Signature Date Requestor is required to submit a completed application to ITD (see below) and to city, county, and/or highway district officials where the requested state route (or state route segment) is contiguous to respective jurisdiction(s). Idaho Transportation Department Attn: Chief Engineer PO Box 7129 Boise ID 83707-1129 or Fax: (208) 334-8195 Email: ITD Use Only Hwy Review Proceed Reject Date D-1 D-2 D-3 D-4 D-5 D-6 Bridge Review Proceed Reject Date Chief Engineer Proceed Reject Date Proceed Reject Date Cc: Local Highway Technical Assistance Council (LHTAC)
4886.docx