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_q.g_ <br />G,dntr or o <br />Orange County Planning a.Atl Inspections Department <br />�p <br />" - BOARD OF ADJUSTMENT — <br />a <br />' GENERAL APPLICATION FORM <br />��rb erce�~�' <br />"NOTE —This form shall accompany all specific application packages as denoted herein ** <br />REQUEST (Check the b ox denoting the purpose of your application to the Board of Adjustment) <br />APPEAL: Fv--1 VARIANCE: ❑ INTERPRETATION: ❑ <br />GENERAL INFORMATION: <br />Date: March 1, 2012�Li'�Ji jZ <br />Property Address: 1907 Orange Chapel Clover Garden Road, Chapel Hill, NC 27516 1 l <br />Applicant: Walt Lobotsky Owner: State of North Carolina 1 l� <br />Address: 6703 Maynard Farm Road Address: UNC- Chapel Dill, 302 -A South Building, CB 91000 <br />Chapel Hill, NC 27516 Chapel Hill, NC 27599 -1000 <br />Phone Number: 919- 883 -4678 Phone Number: 919- 962 -3795 <br />Cell Phone: Cell Phone: <br />Co- signatory: Laura Streitfeld, Board Chair, Preserve Rural Orange, P.O. Box 1314, Carrboro, NC 27510 919 - 593 -5411 <br />Represented by: Johu D. Runkle, Attorney 2121 Damascus Church Rd. Chapel Hill, NC 27516 919- 942 -0600 <br />PROPERTY INFORMATION (IF APPLICABLE): <br />Watershed: Haw River Unprotected Zoning: Agricultural Residential Lot Area: 56.65 acres <br />PIN Number: 9728 -93 -1820 Township: Bingham <br />Subdivision: Deed Book/PageNumber: 229/379 <br />Legal Relationship of Applicant to property owner: Adjacent property owner <br />Preserve Rural Orange is representing neighbors who live adjacent to or in proximity to the site. <br />SUBMITTAL INFORMATION: <br />1) Small Scale Map showing the exact location of property with respect to existing streets, street numbers and size of lots, nature of <br />adjacent property uses, and other important features within and contiguous to the property, <br />2) A completed, signed, Variance or Appeal/Interpretation Form, and <br />3) A Tax Map of the property <br />OFFICIAL USE ONLY: <br />Date Application Properly Filed: > Accepted By: <br />Fee Collected: Receipt Number: Staff Assigned to Review: <br />Date scheduled for PUBLIC HEARING: Date of Sign Posted (if applicable): <br />Notification Letters Required: (Yes) (No) Date Sent: By: <br />Legal Ad Approved by: Dates Published: <br />ABSTRACT Due Date: Completed by: <br />ABSTRACT reviewed by: Approved: (Yes) (No) Date: <br />Date 13OA Packet Sent Out: By: <br />