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APPLICA�oN_FOR <br />. CE�RIMCATION AS QUALMING FARNII.AND ,t% <br />tt'AND DESIGNATION AS' AN ORANGE COUNTY , _', <br />VOLUNTARY <br />AGRICULTURAL DISTRICT' _ -- <br />INSTRUCTIONS: = Befaro =nplcdnS the appheat m, please review the provisions of the orange el _.. . _ . <br />�_" picicrvatl6n Proteins Ordinance; then till aut the form as aoeur d4y and eompieteiy u <br />possible. y Be cre w- --_ - - <br />-- s -• sib acid `date the form, Ind Mum it to the Orange CaurRY ?k mint & Inspections nepaiu mu, 306F Revere . <br />Road, Hillsborough, N.C.'.. -- -- . - -- _ <br />-r - APPLICANT: -•� - _ _ <br />- -Name: � - ..__ .. -. _ . _.__ _ � � - -•- .... _._ - -- - -.. - -._. <br />.. �.. _ <br />'L': .n_ �_ - cam-.. ...- _.. .. -.- ��• :�! ... -• _• -. .. _ .... ✓�c'_- - .a.- -... -. _. _ , <br />Address: 7119 High Rock Rd. <br />_.. __. City:.- Efland -- : - State:.- NC - _ ZIP Code:_ 27243 <br />PhoneNumber:(Home) 563 -3842 (Work) <br />PROPERTY INFORMATION: <br />Property Location/Address: §10 of Hi o k R - <br />- Township: 2 : _... _ _ Tax M 4 2 Block: Lot: I ] A <br />- <br />Parcel Identification Number [PIN]: 9836 -09 -3000 <br />;' : Number of Acres:- _ 1 1 1: 335` "' Deed Book-.'-: 220 age: 195 <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 this land listed for farm present use -value taxation with the Orange County_Taa Office? <br />Yes: `x'°" __. <br />OWNERS] CERTIFICATION:...:: - <br />_ -_.F-•- _ :r.-�_ ''h}•�it••:= ..i.�:.. ______�i_ = - <br />- I [We]; the - aPphcant[sj hereby; certify�that;�• to- the best of_ my (our) ability; the foregoing <br />application is complete and accurate- -�'w •- <br />- Signature: / .r�1d�e . Date:'— <br />- .. <br />..- Signature: , =T i.J ::�: Date:, j - Jr - <br />direct inquiries to: - <br />_ s�i a warms Conservation District.:.�_ -. -. .. - - - _ _ • - - _ . <br />-_ _.._ -- :.E.._ :.. - ` ��=-� Extension Service�:�- <br />­_Lt. Orange County Planning do Yuspeetions Departmeetlt _ <br />