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• 128 MINOR SUBDIVISION APPLICATION ,/o r ,s- <br /> • <br /> Property Owners) + 4,1 / t( J / /; <br /> Address 30 V OSn1 r C.� /f Phone ( ) / .•9-/4 /7 <br /> Developer/Contact Name <br /> - <br /> Address Phone ( ) <br /> Location of Property . . 02 7 4 - <br /> townsltp map block lot. <br /> zoning Fire District <br /> Watershed Impervious Surface <br /> Joint Planning: C.H. Carrboro School District CO <br /> State Road Number /00 4. Name .s_. ,�.-p Type <br /> - <br /> A-/tom$-4u.46Z O <br /> Private Road Class $- Name <br /> Do you plan to build the road before final approval? ye_5 <br /> or secure construction with a security document? <br /> Utilities: Public Sewer Community System Septic Tank Lam' - <br /> Public Waters Community Water Well <br /> If on a septic system, the Health Department must examine all existing and potential- <br /> building sites on lots shown on the plat. <br /> Total Lot Area IT• / �. Number of Lots <br /> Lot Number: Size of Lots: Structures (proposed or existing) : <br /> / - � 7 <br /> I (We) hereby certify that I (we) have read the above information and that the information <br /> I .(we) have supplied is accurate to the best of my (our) knowledge. I (we) understand <br /> r my (our);.application isllnot complete and cannot be approved unless all required information <br /> and material has been provided. <br /> Date Signature • <br /> I - <br /> Date Signature <br /> Filing Fee # of Lots Fee Private Road Fee Other Fee <br /> Total Fees 1 Date Paid <br />