Administrative Application (PDF)

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

Administrative Review Application
Queen Anne’s County Department of Planning and Zoning
110 Vincit Street, Centreville, MD 21617
Telephone: 410-758-1255 Fax: 410-758-2509
EMail: 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(s) (if any): ____________________________________________________________________________
Site Calculations:
Number of Existing Lots: _________ Number of Proposed (Resulting) Lots: _________
Owner/Applicant/Agent:
Property Owner(s) Name(s): ________________________________________________________________________
Property Owner(s) Mailing Address: _________________________________________________________________
City/Town: ______________________ State: _______ Zip: ____________Telephone #:________________________
EMail Address: ___________________________________________________________________________________
Applicant(s) Name(s): _____________________________________________________________________________
Applicant’s Mailing Address: ________________________________________________________________________
City/Town: ______________________ State: _______ Zip: ____________Telephone #:________________________
EMail Address: ___________________________________________________________________________________
Owner’s Agent/Engineer/Surveyor Name: _____________________________________________________________
Firm’s Name: ____________________________________________________________________________________
Mailing Address: _________________________________________________________________________________
City/Town: ______________________ State: _______ Zip: ____________Telephone #:________________________
EMail Address: ___________________________________________________________________________________
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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 any maintenance, easements, utilities, etc.
Is/Are there existing structure(s) on the site 50 years old or older? ☐ No ☐ Yes
If yes, 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 Chesapeake Bay 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
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Agency Review and Submittal Checklist (check all applicable):
Provide a set of the following information for each of the applicable reviewing agencies. Typically the County
Fire/EMS and Local VFD departments do not review Administrative Subdivisions, they are however notified. Planning
& Zoning always gets a copy of documents required for other agencies:
Required Information (3 complete sets required): Staff Verification:
☐ Completed application ☐
☐ Cover letter detailing and describing project ☐
☐ Plat of subject site (must be sealed for approval) ☐
☐ Deed for subject property ☐
☐ Adjacent Property Owner(s) Notification (use the form and attach copies) ☐
☐ Department of Public Works, Engineering Division ☐
☐ Department of Public Health, Environmental Health Division ☐
Additional information, if applicable to project (additional complete sets needed):
☐ Documents for any proposed or revised easements and/or agreements ☐
☐ Department of Planning and Zoning Attorney, provide a copy of the deed, plat, and any legal documents ☐
☐ Economic Development & Tourism Department, Business Liaison ☐
☐ Utility letters for power and telephone companies ☐
☐ Critical Area Commission, provide the CA Worksheet, and supporting documents as necessary ☐
☐ 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 ☐
☐ Forest Conservation, include plats, worksheets, documents, and/or easements ☐
☐ 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 ☐
☐ Incorporated Town, if the project is within a 1 mile radius ☐
Review Fees
$___________ Department of Planning Review Fee*:
Administrative Subdivision without Plat: $100
Administrative Subdivision with Plat: $250 base fee plus $50 for each lot
$___________ Department of Public Works Fee*:
Administrative Subdivision without Plat: No fee
Administrative Subdivision with Plat: $250 base fee plus $25 for each lot
$____________ TOTAL REVIEW FEE FOR PROJECT
* The Director of Planning & Zoning and/or Public Works may reduce fees that are determined to be duplicative or in
excess of the cost to provide the Department(s) review services. (Payment by check written to Queen Anne’s County)
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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: ____________________
Property 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 and/or email.
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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