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3G <br />6. APPLICATION SUMMARY <br />1. Applicant <br />a. Applicant name: Orange County <br />Address: P.O. Box 8181 <br />Town Hillsborough Zip Code 27278 County: _ ___ Orange _ <br />Contact Person: Tara L. Fikes Phone No.: 919-245-2490 Fax No.:919-644-3056 <br />b. Preparer of application (if different from above-: <br />Address: <br />Phone No.: Fax No.: <br />c. Developer: Habitat for Humanity of Orange County, NC, Inc. _ __ <br />Address: P.O. Box 459 ; Hillsborough, NC 27278 _ <br />Phone No: 919-732-6767 Fax No.: 919-732-2337 ~~~~~~~~~ <br />2. Project <br />a. Name: Richmond Hills <br />b. Street address: Richmond Road <br />c. City and county: Efland Community, Or~_n_ge County <br />3. Funding Request <br />ACTIVITY HD FUNDS REQUESTED <br />Infrastructure (public) $250,000 <br />Hazardous material removal <br />Land acquisition <br />Administration <br />Total 5250,000 <br />4. Certification statement: <br />(a1 I certify that to the best of my knowledge and belief: <br />11- Data in this application is true and correct. <br />12) Opportunities have been provided for citizen participation and access to information concerning <br />the proposed activities. <br />131 This document has been duly authorized by the governing body of the applicant, and the <br />applicant will comply with the attached certifications if assistance is approved. <br />Chief Elected Official <br />Printed/typed name of chief elected official <br />Date <br />Title of chief elected official <br />For DCA purposes only: Date received <br />