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`.-- — - grange County - _ _ <br /> Agricultural Districts Advisory Board <br /> APPLICATION FOR CERTIFICATION AS <br /> QUALIFYING FARMLAND <br /> AND DESIGNATION AS <br /> _ VOLUNTARY AGRICUL ORANGE COUNTY <br /> AGRICULTURAL DISTRICT <br /> INSTRUCTIONS:tBefore completing the application, piease review the <br /> .Prsaervation Prognun Ordinance Provisions of the Orange County Voluntary Farmland <br /> rigs and dots the form, and then fill out the form u accurately and completely as possible. ae sure to <br /> realm it to the Oran e <br /> Road, Hillsborough, N.C. g � Planning & Department,DaPartent, 306F Revery <br /> APPLICANT: <br /> . NJO/714) -7C-Zak /)74/Cte/- <br /> Address: lob// Ale,cee(1//I)/L 1. / 1;,41 <br /> City: /1 'E _ / Z ea <br /> State: ZIP Code: 275/ <br /> • Phone Number:(Home) 02?,—C743 <br /> (Work) <br /> PROPERTY INFORMATION: <br /> Property Location/Address: .. f /954: <br /> Township: Tax Map: J/ Block: Lot: 15 <br /> Parcel Identification Number [PIN]: 7',3,: -0 7_a 3 75 <br /> Number of Acres: • Cal Deed <br /> Book: / 4 Page: <br /> Does this land have a plan on file with the Soil Conservation Service or U.S. Forest Service? <br /> • <br /> Yes: - - -No: L___ _______ If "no", please complete back of form. <br /> .. IS this land listed for farm present use-value taxation with the Orana <br /> Yes: /------- No: If "no", please complete back of form. Tax Office? <br /> . --. •-- OWNER[S] CER'i E1CATTON: <br /> - - I (u'e],'the appIicant[s], hereby certify <br /> ._ _-_ _. _ - =^` application is co.1. ete-and-accurate. that, to the best of my [our] ability, the foregoing <br /> Signature: �!`( <br /> Signatu re. _ <br /> Date: <br /> • <br /> __.. Please direct inquiries to: <br /> Orange Soil&Water Conservation District <br /> Cooperative Extension Service <br /> .- Orange County Planning&Inspections Depart <br /> Hai malal•Qapd it;tt 967 STLSI. <br /> Durham 683-7001•M.6.o.727-2031 <br />