Agenda - 09-20-2011 - 5m - Laserfiche WebLink

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Orange Coun Agricultural Preservation Board APPLICATION FOR CERTIFICATION AS QUALIFYING FARMLAND AND DESIGNATION AS AN ORANGE COUNTY VOLUNTARY AGRICULTURAL DISTRICT / ENHANCED VOLUNTARY AGRICULTURAL DISTRICT INSTRUCTIONS: Before completing the-application, please review the provisions of the Orange County Voluntary Farmland Preservation Program Ordinance, and fill out the form as . accurately and completely as possible. Please sign and date the form, and return it to the Department of Environment, Agriculture, Parks and Recreation PO Box 8181 - 306 Revere Road, Hillsborough, NC 27278 APPLICANT: Name: ~~~.(~/'. ~~ Address: 31I ~ d ~~ City: l~~~~,t State. . C. Zip Code: Z 7Z 7~ Phone Number (Day): l ~g Q?q b~~~7 (Evening) E-Mail: PROPERTY INFORMATION: Property Location/Address: 3 ~~ I ~/ ~Q' Parcel Identification Number (PIN): ~~~ ~ ~~`~ Parcel Identification Number (PIN): Parcel Identification Number (PIN)::+~~ac~~`~3!~ Parcel Identification Number (PIN): Parcel Identification Number (PIN): ~~`sr =~~-~~ ~' Parcel Identification Number (PIN): Parcel Identification Number (PIN): ~~sP~''t 3 ~~~ Parcel Identification Number (PIN): Parcel Identification Number (PIN): Parcel Identification Number (PIN): Number of Acres: Deed Book: Page: Does this land have a plan on file with the Natural Resources Conservation Service or NC Forest Service? Yes:~_No: ~ If "No", please complete back of form Is this land listed for Present Use taxation with the Orange County Tax Office? Yes:__ c~No: If "No°, please complete back of form I [WE] ARE SEEKING DESIGNATION AS A VOLUNT-ARY AGRICULTURAL DISTRICT I [WE] ARE SEEKING DESIGNATION AS AN ENHANCED VOLUNTARY AGRICULTURAL DISTRICT OWNER[S] CERTIFICATION: I [We], the applicant[s], hereby certify that, to the best of my [our] knowledge, the foregoing application is complete and accurate. Signature: ,(~% ~`uvf~cr.~ Date: '~' 2. 7-' l ~ _ ,, } Signature: ~- ~ ~ y L~-g~at~: ~~~• ~~ ~ ~ ,'