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Ur �a�uT- <br /> 10 <br /> Date Petition Received by NCDOT: /ag d:s <br /> North Carolina Department of Transportation <br /> Division of Highways <br /> Petition for Road Addition <br /> ROADWAY INFORMATION: (PleasePrintrrype) <br /> County: f Road Name: 4f V49 IZlJ�(- <br /> (Please list additional street names and lengths on the back of this form.) <br /> Subdivision Name: Length (miles): Q <br /> Number of occupied homes having street frontage: Zc::;, Located (miles): p-67 <br /> miles N ❑ S❑ E DQ W ❑ of the intersection of Route 4f 5170 and Route <br /> (Check one) (SR,NC,US) (SR,NC,US) <br /> We, the undersigned, being property owners and/or developers of �- in <br /> County, do hereby request the Division of Highways to add the above described road. <br /> CONTACT PERSON: Name and Address of First Petitioner.(Please Printr type) <br /> Name and Signature: Phone Number: -"7 $R� <br /> Street Address: �1- t'��t, c. 7-7 <br /> Mailing Address: 5"-415� <br /> PROPERTY OWNERS <br /> Printed Name and Signature Mailing Address Telephone <br /> 2'° <br /> C- <br /> Form SR-1 (812022) <br />