Agenda - 01-04-1993 - III-D - Laserfiche WebLink

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fd-17- 41"--r3 3 &al Orange County Agricultural Districts Advisory Board APPLICATION FOR CERTIFICATION AS QUALIFYING FARMLAND AND DESIGNATION AS AN ORANGE COUNTY VOLUNTARY AGRICULTURAL DISTRICT INSTRUCTIONS: Before completing the application, please review the provisions of the Orange County Voluntary Farmland Preservation Program Ordinance, then fill out the form as accurately and completely as possible. Be sure to sign and date the form, and return it to the Orange County Planning &Inspections Department, 306F Revere Road, Hillsborough, N.C. APPLICANT: r' Name: 6"— 7.1 r`W\ Address: () IAA l _ 1 City: JL f� \ State: [/ ( ZIP Code: 1 Phone Number:(Home) �� 1 l� L(Work) �^r4 c� >c, cW > PROPERTY INFORMATION: L Property Location/Address: 0.f\,\, ` �^^�' J' 0✓\ JAR, J , Township: /`",-\-- :J Tax Map: J L/ Block: Lot: / Parcel Identification Number [PIN]: ` --3 (7 ` 1 3 3 I y'7 3, ' 09— Number of Acres: I (� ` Deed Book: 11`75`, Page: 14c,,,3S Does this land have a plan on file with the Soil Conservation Service or U.S. Forest Service? Yes: j ( S No: If "no", please complete back of form. Tc this land listed fer farm recant noe-v .iue t=�otinn with the. Orange Co'mty T_.: Office? rn-'---^- �-- ..._ ----ate ...,_. ^v - Yes: `'c E S No: If "no", please complete back of form. OWNER[S] CERTIFICATION: I [We], the applicant[s], hereby certify that, to the best of my [our] ability, the foregoing application is complete and accurate. Signature: S G , / JriDate: VV`- Signature: � EciAl--et-cc,l pate: A-7. Please direct inquiries to: Orange Soil&Water Conservation District Cooperative Extension Service Orange County Planning&Inspections Department Hillsborough 732-8I81.Chapel Hill 967-9251•Durham 688-7031*Mekme 227-2031