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j �.. 6 <br />NORTH CAROLINA STATE DEPARTMENT OF TRANSPORTATION <br />DIVISION OF HIGHWAYS PETITION <br />North Carolina <br />County of �%✓��r <br />Petition request for (check one) Addition to State System <br />Paving ( ) <br />Maintenance Improvement, <br />We the undersigned, being property owners on r <br />Describe or give local name or <br />Secondary Road Number in r4 n County do hereby request t <br />Division of Highways of the DepartRient of Transportation to Lv�i/� <br />the above- described road. <br />We further advise that the road requested to is <br />in length and at the present time there are occupied homes located on <br />the road and having entrances into the road. <br />Finally, we agree to dedicate to the Division of Highways a right -of -way of <br />the necessary width to construct the road to the minimum construction standards <br />required by the Division of Highways. This right -of -way will extend the entire <br />length of the road that is requested to be improved and will include the necessary <br />areas outside the right -of -way for cut and fill slopes and drainage. Also., we <br />agree to dedicate additional right -of -way in the public road intersections for <br />sight distance and design purposes and to execute said right -of -way agreement <br />forms that will be submitted to us by representatives of the Division of Highways. <br />REMARKS <br />Four copies of recorded subdivision plat enclosed if applicable <br />NAME MAILING ADDRESS TELEPHONE <br />The Division of Highways should contact the first petitioner listed below: <br />Revised Form SR -1 (5 -83) All previous forms obsolete <br />33-x' <br />a <br />Yjf <br />.elf <br />T9 <br />%5 c� <br />"PAS <br />