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NORTH CAROLINA STATE DEPARTMENT OF TRANSPORTATION <br /> D[VISION OF HIGHWAYS PETITION <br /> <br /> County of ....:.- <br /> <br />- Petition request for (check one) Addition to Stat~ System Paving ( ) <br /> Maintenance Improven~nt <br /> <br /> We the undersigned, being property owners on <br /> mm- <br /> '(Describe <br /> [~"cbnd~yRo~d N'a~a~) in............. county do hereby request the <br /> Division of Highways of the Depa~nt df T~anspoFtatlon to ........ __ ...... <br /> the above-described road. <br /> <br />_ We further advise that the ro~d requested to is miles <br /> in length and at the present t!~ there are " occUPied homes located On <br /> the road ~nd 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 /> · g <br /> r~quired by the Division of Highways. This ri hr-of-way will extend the entt~e <br />_ l~ngth of the road that is requested ~o be improved and wtll include the necessary <br />areas outside the right-of-way for cut ~nd fill slopes ~nd drainage. AlsO, we <br />~gree to dedtc~te additional right-ef-~ay in the public road tnter~ections for <br />sight distance and design'purposes anC to execute smd right-of-way agreen~nt <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 OWNCRS <br /> <br />NAM[: ,MAILING ADDkESS TELEPHONE <br /> <br />The Division of Highways should co)~tact %he first petitioner listed below: <br /> <br />2/f ' v ..... ' <br /> <br /> Revised Fern) SR-1 (5-83) All previous forms obsolete <br /> <br /> <br />