Concept Plan Application 2023

Concept Plan Application Queen Anne’s County Department of Planning and Zoning 110 Vincit Street, Suite 104, Centreville, MD 21617 Telephone: 410-758-1255 Fax: 410-758-2509 E-Mail: devrev@qac.org Project Information:

Project Name/Name of Business: __________________________________________________________

Subject Property Street Address: ____________________________________________________________________

City/Town: ____________________________________________ State: MD Zip:__________________________

Tax Map #_________ Block ______ Parcel(s) _______ Lot(s) ________ Tax Acct. #: ___________________________

Total Acreage: _________________ Zoning Designation: ______________ Election District #: _________

Proposal:

Intent and Purpose of Submittal: ____________________________________________________________________

Existing Use (if any): ____________________________ Proposed Use: ____________________________________

Site Calculations:

Existing Square Footage: _________________________ Max. Permitted Square Footage: ______________________

Proposed Square Footage: _______________________ Total Square Footage: ______________________________

Existing Impervious: ____________________________ Max. Permitted Impervious: _________________________

Proposed Impervious: ___________________________ Total Impervious: _________________________________

Min. Required Landscape Area: ____________________ Proposed Landscape Area: _______________________

Existing Parking Spaces: __________________________ Required Parking Spaces: ___________________________

Proposed Parking Spaces: ________________________ Total Parking Spaces: ______________________________

Proposed Number of Commercial Apartments: ____________ Proposed Number of Multi-family Units: ___________

Type(s) of Multi-family Units (circle): Townhome / Apartment / Condominium / Duplex / Triplex / Multiplex / Other Owner/Applicant/Agent:

Property Owner(s) Name(s): ________________________________________________________________________

Property Owner(s) Mailing Address: _________________________________________________________________

City/Town: __________________________ Zip: ______________ Telephone #:_____________________________

EMail Address: ___________________________________________________________________________________

Applicant(s) Name(s): _____________________________________________________________________________

Applicant’s Mailing Address: ________________________________________________________________________

City/Town: __________________________ Zip: ______________ Telephone #:_____________________________

EMail Address: ___________________________________________________________________________________

Owner’s Agent/Engineer/Surveyor Name: _____________________________________________________________

Firm’s Name: ____________________________________________________________________________________

Mailing Address: _________________________________________________________________________________

City/Town: __________________________ Zip: ______________ Telephone #:_____________________________

EMail Address: ___________________________________________________________________________________

Page 1 of 4 6/8/2023 Property Information:

Is Property Currently Encumbered by an Easement: ☐ No ☐ Yes (if yes, please check all applicable easement types, provide the total acreage, and provide the easement document):

☐ Deed Restricted Open Space: ________ ac.

☐ Transfer of Development Rights (TDR) Open Space: ________ac.

☐ Non-Contiguous Open Space: ______ ac.

☐ Agricultural Preservation Easements:

☐ MD AgLand Preservation Foundation (MALPF): _____ ac.

☐ Maryland Environmental Trust (MET): _______ ac.

☐ Rural Legacy: _______ ac.

☐ Conservation Reserve Program (CRP): _______ac.

☐ Utility ☐ Forest Conservation _________ac.

☐ Other (specify type): ________________________________________________________

Is the property within or impacted by a Habitat Protection Area: ☐ No ☐ Yes (if yes, specify): _______________

Growth Area: ☐ No ☐ Yes If yes, check the applicable Growth Area Designation:

☐ Centreville ☐ Chester ☐ Grasonville ☐ Kent Narrows ☐ Queenstown ☐ Stevensville Priority Funding Area (PFA): ☐ No ☐ Yes If yes, number of lots inside PFA: ______________

Is a Comprehensive Water & Sewerage Plan (CWSP) Amendment Required? ☐ No ☐ Yes If so, Current CWSP Designation: ________________________ Proposed CWSP Designation: __________________

Sewage Disposal: ☐ Not Applicable ☐ Public Sewer ☐ On-site Septic Water Supply: ☐ Not Applicable ☐ On-site Well Water ☐ Public Water ☐ Community Well Water New Road Proposed: ☐ Not Applicable ☐ County Dedicated ☐ Privately Maintained Provide supporting documents for maintenance, easements, etc.

Is/Are there existing structure(s) on the site 50 years old or older? ☐ No ☐ Yes If applicable, provide the MD Inventory of Historic Places (MIHP) No. QA #: _______________

To identify the MIHP information, use the Heritage layer via gis.qac.org/propertyviewer Are there any previous applications, subdivisions or related projects? ☐ No ☐ Yes If yes, P&Z File/Application#/Documents: _____________________________________________________________

Chesapeake Bay Critical Area Information:

Is the project within the Critical Area? ☐ No ☐ Yes If yes, check the Critical Area Designation(s):

☐ Resource Conservation Area (RCA) ☐ Limited Development Area (LDA) ☐ Intensely Developed Area (IDA) Critical Area Acreage: ______________ Upland Acreage: _____________ Total Acreage: ____________

Buffer Width (if applicable): ☐ 50ft. ☐ 100 ft. ☐ 200ft. ☐ Expanded Buffer Exempt Area: ☐ No ☐ Yes Does this project require Critical Area review? Use this chart: Threshold for Project Review More information on what may be required for submittal is available at: qac.org/1068/Chesapeake-Bay-Critical-Area Page 2 of 4 6/8/2023 Agency Review and Submittal Checklist (check all applicable):

Provide a set of the following information for each of the applicable reviewing agencies. Planning & Zoning always gets a copy of documents required for other agencies:

Required Information (minimum 2 complete sets required): Staff Verification:

☐ Completed application ☐ ☐ Cover letter detailing and describing project ☐ ☐ Plan of subject site (must be sealed for approval) ☐ ☐ Deed for subject site (one (1) copy only) ☐ ☐ Adjacent Property Owner(s) Notification (use the form and attach copies) ☐ ☐ Department of Public Works, Engineering Division ☐ Additional information, if applicable to project (additional complete sets needed):

☐ Department of Public Health, Environmental Health Division, for projects on private well and/or septic ☐ ☐ Critical Area Commission, provide CA worksheet (2 copies), Environmental Assessment ☐ ☐ Heritage Review, for projects involving or adjacent to structures/landmarks 50 years of age or older ☐ ☐ Department of Parks, for projects within ¼ mile of any parkland, trail, or county-owned land ☐ ☐ Department of Public Works Sanitary District, for projects on public sewer and/or public water ☐

☐ MD State Highway Administration, for projects fronting on a state maintained highway ☐ ☐ Economic Development & Tourism Department, Business Liaison ☐ ☐ Soil Conservation District ☐ ☐ Department of Emergency Services, Fire Marshall Office ☐ ☐ Department of Planning & Zoning Attorney, provide a copy of the deed, plan, and any legal documents ☐ ☐ Local Volunteer Fire Department ☐ ☐ Forest Conservation, include plats, worksheets, documents, and/or easements ☐

☐ Incorporated Town, if the project is within 1 mile ☐ ☐ Bay Bridge Airport, if within ½ mile ☐ ☐ Utility letters for power and telephone companies ☐ ☐ Lighting information and/or plan ☐ ☐ Architectural elevations ☐ ☐ Documents for any proposed easements/agreements regarding access, open space, and/or maintenance ☐ Page 3 of 4 6/8/2023 Certifications/Signatures:

I hereby certify to the best of my knowledge that the information presented in this application is technically correct and accurate to the extent necessary for meeting the Queen Anne’s County requirements for this land use application. A typed signature will not be accepted.

__________________________________________________ Date: ____________________

Owner

OR

___________________________________________________ Date: _____________________

Applicant

AND

___________________________________________________ Date: _______________________

Surveyor/Engineer and/or Owner’s Agent Completeness Review:

The applicant’s failure to address any and all application and checklist items, and those specifications in accordance with the Queen Anne’s County Code, may result in a submittal being considered incomplete. Any such deficiencies will cause the submittal to not proceed for review and may result in the return of the submittal. Only that information provided with the original submittal and in compliance with applicable submittal deadlines will

be reviewed. The submittal will be reviewed for completeness within ten (10) days of receipt. Applicants will receive notification by mail.

For Staff Use Only:

Received By: ___________________________________________________ Date: __________________

Submittal Reviewed for Completeness By: ____________________________ Date:___________________

☐ Complete Submittal.

☐ Incomplete Submittal. If so, list deficiencies: ________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

☐ Complete Re-submittal:

Received By: ____________________________________________ Date: ________________________

Submittal Reviewed for Completeness By: ____________________________ Date:_________________________

Owner and/or Applicant Notified (Date): ___________________________

Mailed Notification on (Date): ____________________________________

Date Stamp Received:

Project Application #:___________________________________

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