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3 <br /> County Board <br /> APPLICATION FOR CERTIFICATION AS QUALIFYING FARMLAND <br /> AND DESIGNATION AS AN ORANGE COUNTY <br /> VOLUNTARY AGRICULTURAL DISTRICT <br /> INSTRUCTIONS: Before completing the application, please review the provisions of the Orange County Voluntary Farmland <br /> Preservation Program Ordinance, then fill out the form as accurately and completely as possible. Be sure to <br /> sign and date the form, and return it to the Orange County Planning&Inspections Department, 306F Revere <br /> Road, Hillsborough, N.C. <br /> APPLICANT: <br /> Name: ■A es r.I <br /> Address: t _co o <br /> City: F L,e.i State: l.,l,.c. ZIP Code: 271 243 <br /> = Phone Number:(Home) O1 s‘3- ■4 (Work) <br /> - i <br /> PROPERTY INFORMATION: <br /> Property Location/Address: /1*.s E <br /> Township: c,\-\E EN,/,.s Tax Map: 4 2- Block: Lot: 14 A- <br /> Parcel Identification Number [PIN]: °! 82 Co - g - t Co S <br /> Number of Acres: 0 Deed Book: 238 Page: t 43 t S <br /> Does this land have a plan�1op� file with the Soil Conservation Service or U.S. Forest Service? <br /> Yes: No: /VG If "no", please complete back of form. ' <br /> Is this land listed for farm present use-value taxation with the Orange County Tax Office? <br /> 1 Yes: No: ,Y6 If "no", please complete back of form. <br /> OWNER[S] CERTIFICATION: <br /> I [We], the applicant[s], hereby certify that, to the best of my [our] ability, the foregoing <br /> application is complete and accurate. <br /> Signature:gn _2Z:hs<.- / Date: JRt1 /9 /99_3 <br /> Signature: %' Yif t Lea -u Date: ,.,,,,., , \"1} 1'k 9 3 <br /> Please direct inquiries to: <br /> Orange Soil&Water Conservation District <br /> Cooperative Extension Service <br /> Orange County Planning&Inspections Department <br /> Hillsborough 732-8181•Chapel Hill 967-9251•nwfiam 6811-7031.Meba a 277-2031 <br />