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0 <br />North Carolina Department of Transportation <br />Division of Highways <br />Petition for Road Addition <br />ROADWAY INFORMATION: (Please Print/Type) <br />County: 0 ra n C Road Name: 0-j u S 1�'U L Cti h e✓ <br />(Please list additional Itreet names and lengths on the back of this form.) <br />Subdivision Name: a /1 �1 a Length (mites): <br />Number of occupied homes having street frontage: /7 Located (miles): b, 4 / Otf, <br />miles N fr3 S 0 E ❑ W fA of the intersection of Route S? �3 and Route fj n 6.n q�r <br />(Check one) (SR, NC, US) (SR, NC, US) <br />We, the undersigned, being property owners and /or developers of c t, S j ck y) ,e in <br />Or 0.n C County, do hereby request the Division of Highways to add the above described road. <br />CONTACT PER$ON: Name and Address of First Petitioner. (Please Printrrype) <br />Name: L r kl. - J 4-L L p y�,e ti(?, jn i RS Phone Number: R/ 9 - `3 ®q— 6 1? 77 <br />Street Address: in 0j Q S e- V 0. 11) e <br />Mailing Address: g ,n -e— I %�.I t i Q % -30 :Z <br />PROPERTY OWNERS <br />Name Mailing Address Telephone <br />a.q W64 Z"-&, fi'l4vr,., . Ah' <br />Form SR -1 (3/2006; Rev 1/2010) <br />