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=IE0 <br />Z7 <br />ffLAPFLICATION FOR. CERTMCATION AS QUALIFYING <br />7.1 <br />DESIGNATION AS AN. ORANGE C0UNty.._,_L,,_ <br />VOLUNTARY AGRICULTURAL DISTRICT T <br />J ---------- <br />- <br />INn`RUC`n0NS:' Before compkdn the appEcation, piesse review •the providona of the <br />Onl�p County Voluntary FannhuW <br />. . . . . . . . . . . . . . . <br />am fin out the form as accurately wO oornplcteV to­.. <br />*=Prtservadon Program Ordinance.9 48 powdble. Be sure <br />agn and date the forni, return R to the Orange County <br />rannins ct Inspections Departnumt, 306F Revere <br />Road ,Hffisbogh, N.C., <br />Name: LVLct_or_CarJ__Wa1Lggs. jr & Elizabpth T,; Wgltprx <br />I_- <br />Address: 7 119 Hikh Rock Rd. <br />: E and City - State:. NC ZIP Code: 27243 <br />Phone Number: (Rome) 563-3842 (Work) <br />PROPERTY INFORMATION: <br />Property Location/Address: of Hish Rock Rd. <br />Township: 2 Tax Map: 4 2 Block: Lot: jjA <br />Parcel Identification Number [PIN]: 9836-09-3000 <br />Acres: 220 Page: 19 5 <br />Number of 335 Deed Book <br />Does this land have a plan on file with the Soil Conservation Service or U.S. Forest Service? <br />Yes: X No: <br />is <br />I ihi laik liit�d for farm present:usvvalue taxation. with the Orange County, Tax Office? <br />des: X. <br />I-— . <br />OWNER[S] ... .... <br />CERTIFICATION:,,— <br />hei6y,_cerdf`y­th' th <br />rw6j,., at; to. e est of my [our] ability the foregoing, <br />­-7 e,- appl 9 <br />application is complete and accurate. 77,",..l <br />Signature: <br />de4 Date- r4 <br />. . ...... .. ate: <br />,Signature D <br />,.:' <br />Please direct inquiries to: <br />CIvarigo Soil Water Conscavation District <br />Caopciative Extanxion service <br />Orange County Phnriing & Inspections Deputrnent,_ <br />Hill. annish 732-9181*C*el HM 967-MIODw @m 688 -7031*Mchm 227-2113I <br />