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I hereby agree to conform to all applicable laws and regulations of the Town of Hillsborough, County of <br />Orange and State of North Carolina (as may be applicable to my request), and certify that the above <br />information and accompanying documents are complete, true and accurate to the best of my knowledge. <br />In addition, I acknowledge that by filing this application, representatives from the Town of Hillsborough <br />Planning Departmerit may enter the subject property for the purpose of investigation and analysis of this <br />request. <br />APPLICATIONS WILL NOT B CCEP.~ WITHO SIGNATU OF PR ERTY OWNER. <br />Applicant Signature: ~~ ~~ ~ <br />Crain Ben ict. Ormve u~t~i in Director Date <br />Property Owner Signature: <br />Frank W. CTf1Yon, Jr., Orange Cou <br />r <br />i'o -27 . << <br />DEPARTMENT USE ONLY Date Received: Staff: <br />ETJ? ^ Yes ^ No Legal Non-Conforming Lot? ^ Yes ^ No Floodplain on Site? ^ Yes ^ No <br />Plus (+) Overlay District? ^ Yes ^ No Flood Zone <br />Historic District Overlay? ^ Yes ^ No Flood Map # <br />Section 4B only - Is the event in the town's jurisdiction? ^ Yes ^ No <br />Zoning Officer's Action on Application: ^ Approved ^ Approved with Conditions ^ Denied <br />Conditions: <br /> <br /> <br /> <br />Comments or Reason for Denial: <br /> <br /> <br />Permit # <br />Zoning Officer: <br /> <br />Date Permit Picked Up: Fee $: <br />(Printed Name) <br />(Signature) Date: <br />Receipt #: . <br />5 of 5 ZCP Application 8/18/2011 <br />