Neighborhood/Subdivision: _____________________________

Name of Neighborhood Contact/Lead Petitioner: _____________

Address: ___________________________________________

Telephone Number: ________________  Fax: ______________

Email: _____________________________________________

Type of Lighting Requested: Standard _____ Decorative _____

Streets to Receive Lights: Street Name ----From----To----

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Return completed form to:
Charlotte Department of Transportation
Public Service & Communications Division
600 East Fourth Street
Charlotte, N.C.  28202-2858
Phone: 704-336-4119
Fax: 704-336-4400

Contact CDOT at 704-336-4119 with any questions.