Orange County NC Website
17 <br />APPLICATION FOR ENVIRONMENTAL ASSESSMENT <br />f: ";;?t- <br />Project Name <br />� <br />Applicant <br />Addr e s s <br />Phone <br />Owner <br />Address <br />Phone <br />C. <br />Location <br />of <br />Property <br />Acreage U? Township <br />Tax Map Reference <br />PIN(S) <br />Zoning District Land Use Plan Category <br />FOR DEPARTMENT USE ONLY <br />Date received Reviewed by <br />Dat ccepte,O/rejected <br />Summary Comments :, <br />\3 eSe ek c <br />cz-, <br />C") C- I l 4 )gt - 5 � t( (2!0 t '>_ <br />