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11 Orange County Agricultural. Districts Advisory Board STAFF CHECKLIST FOR VOLUNTARY AGRICULTURAL DISTRICT SELECTION Date Application Received:_ 2/•02 APPLICANT NAME: ,9P y j L p A]. PROPERTY INFORMATION: 380/ • Property Location/Address: *Township: Ab=M & Ale Tax Map: •Parcel Identification Number [PIN]: *Number of Acres: l'70. 3' leq C CERTIFICATION CRITERIA REVIEW: *Meets acreage requirements of. MAtY S AOAa $ Block: 2 Lot: 15-A / 7 Deed Book: Page: [1] One farm containing at least 80 contiguous acres; OR Yes: -I' No: Initials: Date: Z/-, 0 2 [2] Two or more contiguous farms containing at least 80 acres. Yes: No: Initials: Date: • Participating in farm present use -value taxation program. Yes: ✓ No: Initials• Date: *Certified by Soil Conservation Service as to land suitability. Yes: No: Initials: Date: *Managed in accordance with SCS defined erosion control practices. Yes: No: Initials• Date: *Small lot or tract surrounded by or adjacent to existing /proposed agricultural district. Yes: No: Initials: Date: CERTIFICATION/DESIGNATION ACTION: • Application reviewed for completeness. • Application forwarded to - Tax Supervisor's Office. - Soil Conservation Service. *Evaluation received from - Tax Supervisor's Office. - Soil Conservation Service. *Application presented to Agricultural Advisory Board. [1] Qualifying farmland certification approved. Yes: No: Reason: [2] Recommendation for district designation approved. Yes: No: Reason: *Application presented to Board of Commissioners. [1] Agricultural district designation approved. Yes: No: Reason: [2] Conservation agreement form/content approved. Yes: No: Reason: OConservation agreement signed /recorded. *Agricultural district identified in Land Records System *Agricultural district identified on Tax Map. • Agricultural district sign[s] posted. Date 2• y• 02 2 • iS/• o2 .3- /x•02 3,8.02