Orange County NC Website
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Ike. <br />`;`.%4~'''~~rL'If,h ~ai'3'+'f`~Y1 7~'~^~t~'k.riU`.~.4» nis,rt...r-v ,. ._.....___._. _. <br />WITNESS <br />PROPERTY OWNER (APPLICANT) NAME ~bbott-Bi ~~y-~ <br />COMPANY Black Dia and Pro ertles ..~---- SIGNATURc ~ ~ <br />SIGNATURE _,-'~ ~ xl\~J----~ 221 Providence Road <br />ADDRESS <br />ADDRESS 221 Providence Road Chanel Ail1 NC 27514 <br />Chapel Hill NC 27514 Phone No 919-9290886 ,M1'tT^,ccc <br />AUTHORIZED AGENT <br />COMPANY <br />SIGNATURE <br />ADDRESS phone No. <br />NAME <br />SIGNATURE <br />ADDRESS <br />gpPLICATION RECEIVED BY DISTRICT ENGINEER <br />L <br />APPLICATION APPROVED 8Y LOCAL GOVERNMENTAL AUTHORITY (when required) <br />TITLE DATE <br />SIGNATURE <br />APPLICATION APPROVED BY DISTRICT ENGINEER <br />} -rl <br />INSPECTION BY NCDOT <br />TITLE DATE <br />SIGNATURE <br />COMMENTS: <br /> , <br /> <br /> . <br />f <br />"'~~WAYF~ERMIT - '~ <br />, <br />~~~~ <br /> ;~, <br /> .. <br />. _ ...... ..y <br />~~ ~~ii' <br />i ~;i i Yi'? J: <br />r.. <br />~ <br />Ii ' u <br />. r c~,, . s <br />~, <br />le( 3~(0 ~. <br />