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}. - -ILA' Ofinge ..County: _ <br />- Agricultural Districts Advisory_ Board <br />WEEK <br />-- - Z, v r a!H .sae° <br />_ APPLICATION FOR CERTIFICATION <br />�. _ALIFYIN <br />AND,DES <br />Qv G FARMLAND ,.... ,, . •. w...�;. <br />AS <br />'.VOLUNTARY AGRICULTURAL OR DISi-oRI RECEIVED APR p 9 <br />INSTRUCTIONS: Before cornpledng the application, ply review the provisions of the orange County voluntary Farmland <br />r . sign am Program Ordinance, then fill out the form as aoeunMAW and completely as possible. Be sure to <br />si and date the form' <br />Orange County Planning & inspections Department, 306F Revere <br />. _' _.�. �' and return it to the Oran <br />Road, Hrllaborough, N.C. <br />APPLICANT: <br />Name: Victor Carl Walters Jr & Elizabeth T. Walters <br />Address: 7 1 1 9 High Rock Rd. <br />City: E f land State: NC ZIP Code: _27243 <br />Phone Number: (Home) 563-3842 <br />PROPERTY INFORMATION: <br />(Work) <br />Property Location/Address: N10 1340 <br />Township: _ 2 _ Tax Map: 4 2 Block: Lot: 1 1 <br />Parcel Identification Number [PIN]: 9836-19-5898 <br />Number of Acres: 84 19 Deed Book: 2 2 0 Page: 19 S <br />Does this land have a plan on file with the Soil Conservation Service or U.S. Forest Service? <br />Yes: X No: 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 />Yes: X v No: If- "no ", please complete back of form. <br />OWNERS] CERT ICATION: <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: Date :7, <br />�_ .. Signature 'x.. Date: <br />Please direct inquiries to: <br />Orange Soil & Water conservation District <br />Cooperative Evwnsion Service . <br />Orange County Planning & Inspecdons Department <br />H&Wmush mr:tateasa tau %7- Mj*DwbM MS.- 3teM W= zn -amt <br />