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Divisible Load Permit Application

2. 

3. Wyoming County Highway Department
   4328 State Route 19, Silver Springs, NY 14550<br>Todd Gadd - Superintendent of Highway<br>Phone (585)786-8955<br> Fax (585)786-3297

   4328 State Route 19, Silver Springs, NY 14550
   Todd Gadd - Superintendent of Highway
   Phone (585)786-8955
   Fax (585)786-3297

5. Company Name*

6. Date of Application*
   Date of Application

8. Address*

10. City*

11. State*

12. Zip Code*

14. Phone Number*

15. Email Address

17. Contact Person/Signature*

    By electronically signing this form you agree to this authorization.

19. Total dollar amount mailed (if applying by mail)

    NOTE: Form may be printed and mailed to our offices at Wyoming County Highway Department: 4328 State Route 19, Silver Springs, NY 14550 with appropriate payment fee.
    
    COST: $25.00 per permit prior to issuing Wyoming County Divisible Load Permit. Make check payable to Wyoming County Highway Department. If applying by mail, please include a copy of each truck's current registration and current NYSDOT Divisible Load Permit.
    
    Please note that this permit will expire at the same time that the NYSDOT Divisible Load Permit expires.

21. OR to apply online and pay now
    Click here to pay online with GovPay

    Please pay amount associated with 'Reason for Permit' field that was selected.
    PLEASE NOTE: Upon successful payment thru GovPay please submit application for review using the 'Submit' button or the 'Submit and Print' button

23. Truck Registration

    Please attach an electronic copy of the truck's current registration

24. NYSDOT Divisible Load Permit

    Please attach an electronic copy of the current NYSDOT Divisible Load Permit

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

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