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<br />North Carolina Department of Transporta#ion <br />Division of Highways <br />Petition for Road Addition <br />ROADWAY INFORMATION: (Please PrintlType> <br />County: ~A'AG~ Road Name: C~oP~ ~i ~~ ~~t • bFJC~ <br />(Please list additlonai street names acid lengths on the back or this form.) <br />Subdivision Name: ~7 .:~'..~fi~itJ~z ~ Length (mites): d , <br />Number of occupied homes having street frontage: ~_ Location ,. d. (~~j <br />mites miles N ^ S ^ E [-~j~W ^ of the intersection of Route ~ ~ and Route ~ /~ <br />{Check one) {SR, NC, US) (SR, NC, US) <br />We, the undersigned, being property owners and/or developers of r~-~s;~l~~ U[.~,LS' in <br />(~tz(~~~ County, do hereby request the Division of Highways to add the above described road. <br />CONTACT PERSON: Name acrd Address of First Pe6GOner. (Please PrinUType) <br />Name: ~, kf~tdia~ FGtn~S, Phone Number: ~~.q-g4Z-~!¢~j <br />Street Address: ~, ~ ~ ~~~C,b4~Df~~ ~'. ~-'~APPRt., !-Yft„~~G '7~1 ~- <br />Mailing Address: ~Q-- ~~,~ rid-~/Ylft~ ~~'f'~F~'i~ (,{-.F,~B~1~'-t,t,T/i{G 27~J~ <br />PROPERTY OWNERS <br />Name <br />Mailing Address <br />Telephone <br />Form SR-1 (1/20o1j <br />