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3 <br />Orange County 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 <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, 306E Revere Road, Hillsborough, NC 27278 <br />APPLICANT: <br />.~•- r <br />Name• ~•:~ fit` l ~iJ~f'wt eft d' 1~•r',6"C/1 IG~ ~ <br />~/ <br />City. ~~~~~n ~. State:~Zip Code- .~7 ...3 ~ Z <br />Phonc Number (Day): I~ ~~ ~ 3 ~'`-3 (Evening) ...54/1'10.' <br />)sMail: lU ~r~/t~ f`md111 ~ vn~~r'`i9'irt~ti( ~ L~e'1't <br />1 <br />PROPERTY INFORMATION: <br />Property <br />~~ <br />~- ' ~ <br />p:_ ~f'_ax Map: Block: Lot• <br />Townshi ~;~m le~r>' <br />Parcel Identification Number (PIN): 9~~ ~ " ~9 ' ~,~3q <br />Number of Acres: _~ Q Deed Book:~Page: -x...30 <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 land ' ted 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] knowledge, the foregoing <br />application is complete and accurate. <br />j ~ _ ~~ /) <br />~1~ ~ /C <br />Please direct inquiries to: <br />do Oraage County Environment and Resource Conservation Department <br />306E Revere Road <br />Hlllsborough, NC 27278 <br />Hillsborough ~ 732-818] Chapd Hill • 967-9257 Durham • 688-7331 Mebane • 127-2031 <br />