kentucky transportation cabinet department of vehicle regulation division of motor carriers tc 95-625 rev. 05/2018 page 1 o


KENTUCKY TRANSPORTATION CABINET
Department of Vehicle Regulation
DIVISION OF MOTOR CARRIERS
TC 95-625
Rev. 05/2018
Page 1 of 1
OVERWEIGHT OR OVERDIMENSIONAL PROPOSED ROUTE SURVEY
NOTICE:
This form must accompany form TC95-10.
Please send to:
Fax: 502-564-0992
MAIL TO:
PO Box 2007, Frankfort KY 40602-2007
Phone (502) 564-1257
Drive.Ky.Gov
SECTION 1: APPLICANT INFORMATION
HAULING COMPANY (applicant)
 
USDOT#
 
LOAD DESCRIPTION
 
DATE OF SURVEY
 
OVERALL LENGTH
 
OVERALL WIDTH
 
OVERALL HEIGHT
 
HEIGHT OF POLE (6” above overall height)
 
GROSS WEIGHT
 
ORIGIN (complete address if in KY)
 
DESTINATION (complete address if in KY)
 
ROUTE
 
SECTION 2: ROUTE DETAILS - For additional route details attach a
separate sheet.
The following must be considered while physically performing the
survey.
*
All vertical/horizontal clearance must be checked at the
highest/widest point of the load and lowest/narrowest of the area
where the load will be traveling insuring that all obstructions
can be traveled under, over, or ramped safely
*
No obstruction can be moved or removed without written permission
from the owner.
*
A manufacturer’s specification drawing must be attached.
*
Insure that the weight does not exceed any highway or bridge
posted limit.
*
All loads over 200,000 lbs must attach a side & rear view drawing
with axle spacing & weights.
*
Identify all locations where bucket trucks may be needed.
ROUTE
(Name / Number)
DIRECTION
(N S E W)
LANE OF TRAVEL
(Right, Left, Center, Straddle)
NOTES: INCLUDE ALL OBSTRUCTIONS WITH MILE POINTS
(i.e. bridges, lights, wires, mast arms, trees, signs, poles,
guardrail, railroad, owner of obstruction & contact information if
applicable, etc.)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SECTION 3: SIGNATURE
The Surveyor does hereby certify that the proposed route as requested
above has been physically checked for clearances related to the move
being requested. Furthermore, it is certified that the proposed load
can safely clear every obstacle or bridge structures along the
identified route.
SURVEYING COMPANY NAME
 
SURVEYOR’S NAME
 
PHONE NUMBER
 
SIGNATURE
 
DATE
 
Overnight delivery services: Division of Motor Carriers, 200 Mero
Street, Frankfort, KY 40622

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