We, the undersigned, request that the City of Charlotte install a streetlight on the property line

Between : ___________________________ and __________________ ______ __ _                                                                                    Address & Street

Neighborhood or Subdivision ____________________________________

Below, find a signature from each property owner within 75' of the proposed streetlight location. We understand that the Charlotte Department of Transportation has the final authority to determine the placement and type of streetlight to be installed.

_______________________________  ________________________  _________
Printed Name of Lead Petitioner          Address                                Telephone

_______________________________
Signature of Lead Petitioner

Property Owner/
Resident Signatures                       Address                          Telephone

___________________________    ____________________    __________

___________________________    ____________________    __________

___________________________    ____________________    __________

___________________________    ____________________    __________

Return Petition to:
Charlotte Department of Transportation  
Public Service Division
600 E. Fourth Street 
Charlotte, NC 28202-2858
Phone: (704) 336-4118
Fax: (704) 336-4400