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AU:it 14-141-1, . . <br /> MINOR SUBDIvISJON APPLICATISN 4 <br /> Property Owner(s) , ,, i ,eT\ C)cAzr.,[N ___________________ <br /> Address .1 Phone ( 11"1 ) <br /> Developer/Contact Name _ <br /> Address Phone ( <br /> Location of Property Atl ,6("i10 . . 447 1/ <br /> township map block lot <br /> Zoning /24 MTC Fire District OPAAJae <br /> • <br /> Watershed /VA impervious Surface <br /> . - <br /> Joint Planning: C. H. Carrboro School District pc- <br /> State Road Number 10 Name 4e4 No <br /> Private Road Class *C' . ' Name <br /> 4)=55 MAN -,bu PERT <br /> Do you plan to build the road before final approval ? NA <br /> or secure construction with a security document? MX <br /> - <br /> Utilities: Public Sewer Community System— Septic Tank <br /> - Public Water - Community Water - Well <br /> If on a septic system, the Health Department must <br /> examine . all '=: existing and- potential building sites on <br /> Jots shown on the plat. <br /> • <br /> Total Lot Area Number of Lots <br /> Lot Number: Size of Lots: Structures (proposed or existing) <br /> y <br /> jsc, UhOn6 houce.-- <br /> 1.0" • <br /> - <br /> I (We) hereby certify that I (we) - have read the above infor- <br /> mal- ion and that the information - I (we) have supplied is - <br /> accurate to the best of my (our) knowledge. A (We) under- - -- <br /> stand my (our) application is not complete and cannot be - - <br /> approved unless all required information and material has <br /> been provided. <br /> _ <br /> 4)-1I:l_f0c6 • \ rIlt:stse■ .si.)9&k <br /> Date Signature <br /> Date Signature <br /> Filing Fee 1/0 f of Lots Fee /0 Private Road Cep, '190 <br /> Other Fee V Total Fees Date Paid /2--V-Vb <br /> 214V/ <br />