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6 <br /> Orange County <br /> Agricultural Districts Advisory Board <br /> APPLICATION FOR CER'11HCATION 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 County Voluntary Farmland <br /> Preservation Program Ordinance, then fill out the form as accurately and completely as possible. Be sure to <br /> sign and date the form, and return it to the Orange County Planning&Inspections Department, 306F Revere <br /> Road, Hillsborough, N.C. <br /> APPLICANT: <br /> Name: Victor Carl , Jr . & Elizabeth T . Walters <br /> • <br /> Address: 7119 HIGH ROCK RD. <br /> City: E f l a n d State: NC ZIP Code: 27243 <br /> Phone Number:(Home) 563-3842 (Work) <br /> PROPERTY INFORMATION: <br /> Property Location/Address: 7400 High Rock Rd . <br /> Township: 2 Tax Map: 42 Block: Lot: 118 <br /> Parcel Identification Number [PIN]: 9826-99-7912 <br /> Number of Acres: 1 .02 Deed Book: 346 Page: 686 <br /> Does this land have a plan on file with the Soil Conservation Service or U.S. Forest Service? <br /> • Yes: No: X : If "no", please complete back of form. ' <br /> Is this land listed for farm present use-value taxation with the Orange County Tax Office? <br /> Yes: No: X If "no", please complete back of form. <br /> OWNER[S] CERr1FiCATIONe <br /> I [We], the applicant[s], hereby certify that, to the best of my [our] ability, the foregoing <br /> application is complete and accurate. <br /> Signature:(f�c, .ri('siz�t�J� Date: '1- 016 - 9 3 <br /> Signature: Date: 1- / <br /> Please direct inquiries to: <br /> Orange Soil&Water Conservation District <br /> Cooperative Extension Service <br /> Orange County Planning&Inspections Department <br /> HIll+borouth 732-8181•Chapel Hfill 967-9231•Durbom 6U-7031•Mebo. 727-2231 <br />