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2 ENEYV~~ ~ <br />OI°alege C_.ounty Agl°icultul°al Pr°eservata'on Board <br />APPLICATION FOR CERTIFICATION AS QUALIFYING FARMLAND <br />AND DESIGNATION AS AN ORANGE COUNTY <br />VOLUNTARY AGRICULTURAL DISTRICT <br />INSTRUCT-IONS: Before completing the application, please review the provisions of the Orange <br />Connty 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: Victor Carl Walters Sr. <br />Address: 7581 High Rock Road <br />City: Efland. State: NC Zip Code: 27243 <br />Phone Number (Day): 563-3894 (Evening) <br />PROPERTY INFORMATION: <br />Property L ocation/Address: N/O Hieh Rock Road <br />Townslrip: Cedar Grove Tax Map: 42 Biock: 5 L.ot: 14 & 14B <br />Parcel Identification Number (PIN): 9827-81-8701 & 9826-89-6746 <br />2.42..x'14 2.42..14B <br />Number of Acres: 183 Deed Book: 206 Page: 189 <br />Does this land have a plan on file with the Natural Resources Conservation Service or NC Forest <br />Service? <br />Yes: X No: If "No", please complete back of form <br />Is this land listed for Present Use taxation with the Orange County Tax Office? <br />Yes: X 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 />'~~ _.r~ L <br />n <br />Signature:'~~~/ ,~:_.~`:- r"+,~ ~~~%~'~~~'Date: / ~ `-~~ ~~ <br />Signature: /1 fG~1 0 ~!~ ~~yl ~- ~~~- Date:~.~-. - ~ ~ '7 <br />Please direct inquiries to: <br />rlo Orange County Euviranmeu! and Resoarce Conserrnrinn Depnrnnen! <br />306~t Revcrc Road <br />N!llsborongh, NC 27278 <br />Iiiflsborougb •732-8/87 Cbrspef Nr/[•9G7-915] Drvban+•G88-2331 T9ebnne •227-2037 <br />