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C~"ra~~ge bounty Agricultural 1?istriets ~4dvis~ry hoard <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 <br />County Voluntary Farmland Preservation Program Ordinance, then fill out the <br />form as accurately and completely as possible. Please sign and date the form, and <br />return it to the Orange County Environment and Resource Conservation <br />Department, 306A Revere Road, Hillsborough, NC 27278 <br />APPLICANT: <br />Name: 50.fr~ °~ C-,o,: ~ ~piAc~S C hod 4-°M~;ev~ ~o~eQS <br />Address: 3b S ~ea~sUr. ~. ~?91 S~ear~son mod. <br />city: -~-(u~r• d 1 e (~'~ ~ Us State• NC- Zip <br />Phone Number <br />E-Mail: 1C.t*~~WOocIS °` _ nCSG. le~w <br />PROPERTY INFORMATION: ^~, _ _ ;~, <br />Property Location/Address: J ~ ~ 5 ~Aotl~~ ~ °~~~ '~5~~°i~O2~ ~ ~~ '~ ~ ~ ~M <br />-1 a. Pr ~- <br />Township: ~' C~~ Cart~trt_ Tax Map: -3~J Block:~,_t Lot: <br />~t~s~~sgag~ls ~g~ggl9~i~~al$~5 <br />Parcel Identi5cati~ umber (Pq q $ ~ 15 ~5 y~ <br />Number of Acres: 10.3 13.Li~eed Book: X495 't/bl~age: `'lbb 3gdh <br />Does this land have a plan on file with the Natural Resources Conservation Service or NC Forest <br />Service? <br />Yes: No:~_If "No", please complete back of form <br />is this lapd listed for Present Use taxation with the Orange County Tax Office? <br />Yes: 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] lmowledge, the foregoing <br />application is Mete and accur/at~r <br />Please direct inquiries to; <br />do Orange County Environment and Resource Conservation Department <br />306F Revere Road <br />Hillsborough, NC 27278 <br />Hillsborough • 732-8181 Chapel HiU • 967-9251 Durham •688-7331 Mebane • 227-2031 <br />