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. --:i <br /> MINOR SUBDIVISION APPLICATION • <br /> o <br /> Property Owner(s) i2_ w <br /> rAddress 1,24. 2 3/ C.-/�y Phone ( ) <br /> Developer/Contact Name )yj s,A .i—,. • 03 -:n Ad . <br /> Address Phone ( ) • <br /> Location rn of Property- C/7r . /fit- . . d . <br /> township map block lot <br /> Zoning R- j/iO - Fire District . L. .c.,6 <br /> Watershed v . I-- .. Impervious Surface `off- 917 <br /> Joint Planning: C.H. Carrboro Carrb1-•"--- <br /> - School District <br /> • State Road Number I/"© I Name_ /h�G.c, ..s ype �Q <br /> Private Road Class 4 Name 670_,4,4_2 ., <br /> Do you plan to build the road before final approval? �• C.a <br /> or secure construction with a security document? c�7 <br /> Utilities: Public Sewer Community System Septic Tank <br /> Public Water 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 /> . <br /> Total Lot Area o A C Number of Lots °2 <br /> Lot Number: Size of Lots: Structures (proposed or existing) : <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 /> my (Our) application is not complete and cannot be approved unless all required information <br /> and material has been provided. <br /> 171- `,�'/ - 927L;A., (" a."7,41..;iv <br /> Date. Signature <br /> Date Signature <br /> Filing Fee T of Lots Fee Private Road Fee Other Fee <br /> Total Fees Date Paid <br />