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G 1 6 <br />North Carolina Department of Transportation <br />• Division of Highways <br />Petition for Road Addition <br />ROADWAY INFORMATION: (Please PrintrType) <br />County: e~ Road Name: <br />(Please list additional street names and lengths on the back of this forth.) <br />Subdivision Name: \ c \1k\c,nc`J Length (miles): O~ r \lQ <br />Number of occupied homes having street frontage: Located (miles): <br />miles N CJ E] EE] WE] of the intersection of Route and Route SCL QeQ <br />(Check one) (SR, NC, US) (SR, NC, US) <br />We, the undersigned, being property owners and/or developers of li, \ t,k~ 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 PrinUrype) <br />Name: Phone Number. ( c `r-)'A ~ <br />Street Address: C~) ~J \ar W :v e <br />Mailing Address: --7~) ck- ~ fir) C ( S~ E <br />PROPERTY OWNERS <br />Name <br />L~c,~~'4 <br />Mailing Address <br />,t 1 p g <br />a~~33 <br />Telephone <br />-0)9( <br />G t 2 5452 I O <br />~G <br />~1n-P -SSti3 <br />'R000L <br />VA'C` <br />1 ZSC~ ~~\Ci <br />Y~c-~.;. SXV-~ <br /> <br />Form SR-1 (3/2006. Rev 1/2010) <br />