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a <br />f <br />North Carolina Department of Transportation ' <br />Drvtsion of Highways <br />Petition for Road Addition AUG 2 7 ;2010 <br />iu. v. r~Wt~ ~= ~~s~'~ <br />` ~ +~ N9 <br />ROADWAY INFORMATbN: (Please Print/rype) <br />Coun Ol ~! ~ Road Name: ~ V 00~1~ ~ rk 1~n~ <br />~ ire ~ ~, s~ names ana ~«,~ on ~e hack oP this ~-.~ <br />~OO(A ~I Y~~ Length (mass): ~~ ai ~ f~~ j~~J <br />Subdivision Name: <br />Located (miss): ~ r ~t~ t/S <br />Number of occupied homes having street frontage: ~! <br />miles N~[S ^ E ^ W ^ of the intersection of Route " ~~ and Route NC' 'p~Q _ <br />(Check one) R, NC, US) t ~/' (S P1 . US7 <br />owners and/or developers of Y Y t~~l]~ in <br />We, the undersigned, being property <br />~ra~~{~ County, do hereby request the Division of Highways to add the above described road. <br />V .. <br />CONTACT PERSON: Irame arrd Address of First Pet#arer. (P~ase prinvType) <br />Nairie: ~ U~ ~G -J ~h .~j0 <br />Street Address: _,~ YV~~ 1Y!'` ~9~~~ <br />Mailing Address: 59nt~/ ~ ~ ~f'~ ~e <br />6 ~~~ ~r'~o~ l a ~ ~o~JG'rk ~ P~~n~~~s' <br />Name <br />Mailing Address <br />Phone Number. ~~ ~! ~ ~~ ~ <br />~-~1 ~~i1 ~ Nc ~~~~~ <br />9 <br />~~,n~~ a~~~~- ph~~ q~q-9~a-~9t$ <br />Telephone <br />Form SR-1 (312006; Rev 1/20 ` ) <br />