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2 <br />Orange County <br />- <br />Agricultural Districts Advisory 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 u accurately and completely as possible. Be sure to <br />sign and date the form, and return it to the Orange County Planning & Inspections DepaRment, 306F Revere <br />Road, Hillsborough. N.C. <br />APPLICANT: <br />Name: Victor Carl, Jr. & Elizabeth -T. Walt:'ers <br />Address: 7119 HIGH ROCK RD, <br />City: Efland <br />State: NC ZIP Code: 27243 <br />Phone Number: (Home) 563-3842 (Work) Same <br />PROPERTY INFORMATION: <br />Property Location/Address: N/ 0 High Rock Rd <br />Township: <br />2 <br />Tax Map: 42 Block: Lot: 5 <br />Parcel Identification Number [PIN]: <br />9837 -03-2356 <br />Number of Acres: 45. 33 Deed Book: 2 0 6 Page: 18 9 <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 No: 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:dL" L j.,, , v a, _. _ Date: .3 D /g 9,g <br />Signature: [. LcJa z. Date: -1/ - 3o - / g T a <br />Please direct inquiries to: <br />Orange Soil & Water Conservation District <br />Cooperative Extension Service <br />Orange County Planning & Inspections Department <br />Hinsbwo* 7e24181►Cmpd HM W7- Mt9aurhzm US -7W1• =7-2W1 <br />