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3 <br />VOLUNTARY AGRICULTURAL DISTRICT <br />INSTRUCTIONS: Before completing the application, please review the provisions of the Orange <br />County Voluntary Farmland Preservation Program Ordinance, then fill out the <br />form as accurately and completely as possible. Please sign and date the form, and <br />return it to the Orange County Environment and Resource Conservation <br />Department, 306A Revere Road, Hillsborough, NC 27278 <br />APPLICANT: <br />1' pww~rs r <br />Name:... ~ (Y61~-&. ~G,Ir"vn ~ L~ C ~.VLAI~,U^f ; ~r-~A,Iti '1' ~1'~ ~ I <br />Address~~:~~~~`.Z~~ ~~w+~.eww ~' ~' <br />City: C~1'Wd~- ~? (( State: NL Zip Code: ~~ ~ L <br />Phone Number (Day): 4 ~ ~ ' a ~-3 - o s 3t (Evening) q ig' 9 6 ~ - (Q G ~ ~ <br />E-Mail: ~~.~ta.YI1.1 @ f'1Afi'~l(M,~ ' fdYY~ <br />PROPERTY INFORMATION: <br />Property Location/Address: [ ~ !l.(.~ j'1•kA Fd.t^h'1 ~A~'u- <br />Township:~T ~fti-1 d Tax Map: Block: Lot: <br />ry~,Q,~j~le- Parcel Identification Number (PII~: <br />~~G~ Number of Acres: Deed Book: Page: <br />Sr~C.'E'i <br />Does this land have a plan on file with the Natural Resources Conservation Service or NC Forest <br />Service? <br />Yes: t~ No: If "No", please complete back of form ~'~` <br />Is this land listed for Present Use taxation with the Orange County Tax OfFice? <br />Yes: / No: If "No", please complete back of form <br />OWNER[S] CERTIFICATION: <br />I [We], the applicant[s], hereby certify that, to the best of my [our] knowledge, the foregoing <br />application is complete and accurate. <br />~: <br />~ l 3v l08 <br />w~ V Y <br />Signature: 'L ~ Date: ~ f ~--~ C~ <br />Please direct inquiries to: <br />do Orange County Environment mid Resource Conservation Department <br />30f,F Revere Road <br />Hillsborough, NC 27278 <br />Hillsborough • 732-8181 Chapel Hill • 967-9251 DurJtam • 688-7331 Mebane • 227-2031 <br />