Minor Site Plan Application

Document Date unknown · 4 page(s) in the original

This is the document's text, extracted automatically. Headings and paragraphs are inferred from the original's layout, so the arrangement may differ from the published version — the words do not. Where it matters legally, the original governs.

Original document ↗

Minor Site Plan Application Project Name/Name of Business: __________________________________________________________

Subject Property Street Address: ____________________________________________________________________

City/Town: ____________________________________________ State: MD Zip: __________________________

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