Minor Site Plan Application

Exactly as extracted, unformatted — for checking against the original. The readable version is easier to read.

Minor Site Plan Application
Project Name/Name of Business: __________________________________________________________
Subject Property Street Address: ____________________________________________________________________
City/Town: ____________________________________________ State: MD Zip: __________________________
Tax Account #: ________________________________ Map: _______ Block: _______ Parcel: _____ Lot: _______
Tax Account #: ________________________________ Map: _______ Block: _______ Parcel: _____ Lot: _______
Tax Account #: ________________________________ Map: _______ Block: _______ Parcel: _____ Lot: _______
Total Acreage: _________________ Zoning Designation: ______________ Election District #: _________
Proposal:
Intent and Purpose of Submittal: ____________________________________________________________________
Existing Use (if any): ____________________________ Proposed Use: ____________________________________
Solar Project 5MW or less: ☐ No ☐ Yes
Total Solar Project Area (in acres): ____________ Is this an Energy Storage Project: ☐ No ☐ Yes
PPA Solar Project Area (in acres): ____________ Class 1 Soils Area: (in acres): ____________
Site Calculations:
Existing Square Footage: ________________________ Max. Permitted Square Footage: _____________________
Proposed Square Footage: _______________________ Total Square Footage: _____________________________
Existing Impervious: ____________________________ Max. Permitted Impervious: ________________________
Proposed Impervious: __________________________ Total Impervious: _________________________________
Minimum Required Landscape Area: _______________ Proposed Landscape Area: __________________________
Existing Parking Spaces: _________________________ Required Parking Spaces: ___________________________
Proposed Parking Spaces: ________________________ Total Parking Spaces: ______________________________
Owner/Applicant/Agent:
Property Owner(s) Name(s): ________________________________________________________________________
Property Owner(s) Mailing Address: _________________________________________________________________
City/Town: __________________________ Zip: ______________ Telephone #:_____________________________
Electronic Mail Address: ___________________________________________________________________________
Applicant(s) Name(s): _____________________________________________________________________________
Applicant’s Mailing Address: ________________________________________________________________________
City/Town: __________________________ Zip: ______________ Telephone #:_____________________________
Electronic Mail Address: ___________________________________________________________________________
Owner’s Agent/Engineer/Surveyor Name: _____________________________________________________________
Firm’s Name: ____________________________________________________________________________________
Mailing Address: _________________________________________________________________________________
City/Town: __________________________ Zip: ______________ Telephone #:_____________________________
Electronic Mail Address: ___________________________________________________________________________

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 the 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
__________________________________________________________________________________________________
Last Updated: October 2025 Page 2 of 4

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 Marshal 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 ☐
☐ Any other supporting documents or departments as may be necessary (List): __________________________ ☐
* The Director of Planning & Zoning and/or Public Works may waive part/all fees that are determined to be
duplicative or significantly in excess of the cost to provide the Department(s) review services.
_ _ ________________________________________________________________________________________________
La st Updated: October 2025 Page 3 of 4

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 #: ___________________________________________
__________________________________________________________________________________________________
Last Updated: October 2025 Page 4 of 4