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10 i MINOR SUBDIVISION APPLICATION <br /> i <br /> Property Owner(s) 90,42 >ed 6574-e- r <br /> Address //2„25-- n . ( ,,,,, ,„, 4..- . /erg- Phone ( ) <br /> UevUl e-r/Contact Name_ prIL� <br /> Address /24 //1,,C 4p 6p 4 Gc-/ /4: Phone ( ) / 307 - a. --/,(---- <br /> Location of Property C /&) <br /> township map block lot <br /> Zoning R - / Fire District 6 <br /> Watershed ` Impervious Surface <br /> - <br /> Joint Planning: C.H. • Carrboro School District <br /> State Road Number 1'"'"�'- 4 Name = _ Type <br /> Private Road Class /- 0R' <br /> V B£(C, Name 20-T-) <br /> Do you plan to build the road before final approval? 1lC1- <br /> or secure construction with a security document? JJ <br /> Utilities: Public Sewer Community System Septic Tank L---"' <br /> Public Water Community Water Well t� <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 I 6, Number of Lots <br /> Lot Number: Size of Lots: Structures (proposed or existing) : <br /> /0,4% etc,. -4rvc.X----' <br /> - <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 an annot be approved unles all required information <br /> and material has been provided. <br /> 6 -- i— g f° [10,Affas h <br /> Date Signature <br /> ,.�,Ar T _!.tom• <br /> Date Si. • ure <br /> Filing Fee # of Lots Fee Private Road Fee Other Fee <br /> Total Fees Date Paid <br />