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North Carolina <br />County of ~ bm wv't~ 5 <br /> <br />Petition request for (check one) <br /> <br /> J2 ) c.. <br /> <br />NORTH CAROLINA STATE DEPARTMENT OF TRANSPORTATION~ <br /> DIVISION OF HIGHWAYS PETITION ~ <br /> <br />Addition to State System <br />Paving { ) .4)iSTRtCT <br />Maintenance Improvement ( ) . "4~vls4tti~l~ . <br /> <br /> We the undersigned, being property owners on <br /> '{DeScribe or give local name or <br />SecondarY Road Number) in ~~,~ ~ County do hereby request the <br />Division of Highways of the De~Ertment of Transportation to ~7~ <br />the above-described road. <br /> <br /> We further advise that the road requested to ~p ~ is o.~ miles <br />in length and at the present time there are --~]occu~ied'homes located 'on ..... <br />the road and having entrances into the road. <br /> <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 desig~ 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 /> <br />REMARKS <br /> <br />Four copies of recorded subdivision plat enclosed if applicable <br /> <br /> PROPERTY OWNERS <br /> NAME MAILING ADqRE~S4A'~j <br /> The Division of HighWays should contact the~/first~eti~toner, n~ed~. ~__ .~. ~a~rbel°w: <br /> <br />~ .... . ~ .. - ~-. ,~ ..... ~ .... <br /> <br />Revised Form SR-1 (5-83) All previous forms obsolete <br /> <br /> <br />