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3 <br />f ~ <br />Or°ange County Agricultural Preservation Soard <br />APPLICATION FOR CERTIFICATION AS QUALIFYING FARMLAND <br />AND DESIGNATION AS AN ORANGE COUNTY <br />VOLUNTARY A(TRICULTURAL 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, 30GA Revere Road, Hillsborough, NC 27278 <br />APPLICANT: t_ I / <br />Name:'~r~ aI~ ~! ~1'r ;I ~=~I7 r~~E ~ n ~1/cl~~Cr'1^ <br /> <br />~ U <br />City: ~ ~~ a I't ~ State:~~~_Zip Code: ~ ~ ~ ~ -3 <br />Phone Number (Day):~91 (~ rJ GG 3 ' ~ `~tl ~ (Evenina) <br />0 <br />PROPERTY INFORMATION: <br />` / r~ j <br />' Property Location/Address: ~V 6 Y` ~- ~'\ D t~ l'~ + ~~ ` ~ <br />Township:L-'u"~y-~--~~w-~-"=~ TaxM,~aJp: ~~ Block:`/~Lot:~_ <br />Parcel Identification Number (PII~: 9 n a ~ y ~~ - ~ `3 ~ Y <br />Number of Acres: ~ ~ 3 Deed Book: 3 3 <> 1 Page: /. `~ <br />Does this land have a plan on file with the Natural Resources Conservation Service or NC Forest <br />Service? <br />Yes: r'~ No: It "No'", please complete back of form <br />Is this land ]fisted for Present Use taxation with the Orange County Tax Office? <br />Yes: No: If "No", please complete back of form <br />,~; ~~ <br />l-1 P '' <br />OWNER[S] CERTIFICATION: <br />I [R'e], the applicant[s], hereby certify that, to the best of my [our] knowledge, the foregoing <br />application is complete and accurate. <br />Si afore: /~.Xllea.~ ~ r Date: <br />~ -- O <br />Please direct inquiries to: <br />c/o Orange Coanty Environment and Resmuce Consernation Deparhnen[ <br />306A Revere Road <br />llillsbormrgh, NC ?7?78 <br />Iiillsboraagl: •7.33-8187 Chapel liil! • 9G7-9~S1 Durham •G83-73.31 hlebmre •??7-20.?I <br />