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C 1 5 <br />North Carolina Department of Transportation <br />• Division of Highways <br />Petition for Road Addition <br />ROADWAY INFORMATION: (Please Pdntfrype) <br />County: <br />:-w <br />Road Name <br />(Please list additional street names and lengths on the back of this form.) <br />Subdivision Name: \ \\cr Length (miles): <br />Number of occupied homes having street frontage:Located (miles-): <br />miles N d S ❑ E ❑ W F-1 of the intersection of Route 5'~ h 3~ and Route SQ, \ c -D <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 or First Petitioner. (Please Print/Type) <br />Name: <br />Phone Number: 11Zt- 3\y <br />Street Address: <br />`l 30\ \\ct <br />c~ ~c <br />~o r ~~'3 \~C- 1ti 33 i <br />Mailing Address: <br />Name <br />0 <br />~c <br />PROPERTY OWNERS <br />` Wailing Address <br />\ 1 \ <br />~ <br />lt5 <br />-C~L <br />- aq <br />~S7 3°i <br />Telephone <br />l a~clR ~~t\~~ <br />Form SR-1 (32006; Rev 112010) <br />