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INSTRUCTIONS FOR COMPLETING PETITION: <br />1. Complete Information Section <br />2. Identify Contact Person (This person serves as spokesperson for petitioner(s)). <br />3. Attach two (2) copies of recorded subdivision plat or property deeds, which refer to candidate road. <br />4. Adjoining property owners and/or the developer may submit a petition. Subdivision roads with prior <br />NCDOT review and approval only require the developer's signature. <br />5. If submitted by the developer, encroachment agreements from all utilities located within the right of <br />way shall be submitted with the petition for Road addition. However, construction plans may not be <br />required at this time. <br />6. Submit to District Engineer's Office. <br />FOR NCDOT USE ONLY: Please check the appropriate block <br />❑ Rural Road ❑ Subdivision platted prior to October 1, 1975 [Subdivision platted after September 30, 1975 <br />REQUIREMENTS FOR ADDITION <br />If this road meets the requirements necessary for addition, we agree to grant the Department <br />of Transportation a right -of -way of the necessary width to construct the road to the minimum <br />construction standards of the NCDOT. The right -of -way will extend the entire length of the <br />road that is requested to be added to the state maintained system and will include the <br />necessary areas outside of the right -or -way for cut and fill slopes and drainage. Also, we <br />agree to dedicate additional right -of -way at intersections for sight distance and design <br />purposes and execute said right -of -way agreement forms that will be submitted to us by <br />representatives of the NCDOT. The right -of -way shall be cleared at no expense to the <br />NCDOT, which includes the removal of utilities, fences, other obstructions, etc. <br />General Statute 136 -102.6 states that any subdivision recorded on or after October 1, 1975, <br />must be built in accordance with NCDOT standards in order to be eligible for addition to the <br />State Road System. <br />ROAD NAME <br />HOMES <br />LENGTH <br />ROAD NAME HOMES LENGTH <br />VJeM.4F4PTdN WAY <br />10 <br />Z,CW <br />w61.zanJ LAN& <br />3 <br />7zo <br />r "KFOP -D CoupzT <br />4 <br />360 <br />Form SR -1 (3/2006; Rev 112010) <br />