ENVIRONMENTAL APPLICATION FORM Payment by check_ money order or by dfhdhdhdhjr


									         M-NCPPC  Countywide Planning Division, Environmental Planning Section                         Effective June 2011
         Prince George’s County Planning Department14741 Governor Oden Bowie Drive, Upper Marlboro, Maryland 20772 301-952-3650

                                       ENVIRONMENTAL APPLICATION FORM
                                                APPLICANTS DO NOT WRITE IN THIS SPACE
   Plan Type: Exemption Letter ____ TCP2 (SF) ____ TCP2 (MF or C) ____ Case No.(s): _______________________________
   Acceptance Date: ___________________        Plan Reviewer: ________________________ Receipt Number ________________
   Filing Fee: __________________ Calculation Method: (for TCPs only) ______________________________________________

                                            APPLICANT TO FILL OUT ALL REMAINING SECTIONS
 Payment by check, money order or cashier’s check ONLY – made out to M-NCPPC
 APPLICATION TYPE: ___ Letter of Exemption from Woodland Conservation Ordinance ($50)
                   ___ Type 2 TCP for single-family residential use or Off-Site Woodland Conservation Bank ($50 plus $10 per lot or parcel)
                   ___ Type 2 TCP for multi-family or non-residential use             ($100 plus $25 per acre)

 Name on Check: __________________________ Check No. _______             Revision to Approved Plan # ______________

 Geographic Location (related to or near major intersection):

 Street Address (if available):
 Companion Case(s):
 (TCP1, TCP2, Preliminary Plan, Site Plan or Special Exception)(If SDP or DSP, the TCP2 is submitted to DRD with the companion case)
 Total Area (acres):                                              Tax Map/Grid:                              Council District:
 Total Number of Lots or Parcels:                                 WSSC Grid:                                 Election District:

 Lot Numbers/Blocks/Parcels:                                      Plat Book/Page:                            Planning Area:

 Subdivision Name:                                                Municipality(ies):                         Policy Analysis Zone:

 Current Zone:                                                    Overlay Zone:                              Tax Account Number:

 Tier:    Developed or Developing or Rural                        Subwatershed:                              Basin: Anacostia or Potomac or
 Is this site in a Priority Funding Area (PFA)? Yes       No
 Is there a historic site or resource on the subject property?    Yes    No              Historic Site ID ____________________
 Has a Historic Area Work Permit (HAWP) application been filed with the Historic Preservation Commission? Yes No

 Proposed Use of Property, Proposed Activity and/or                  List and provide copies of resolutions of previously approved applications
 Request:                                                            affecting the subject property or state not applicable (N/A):

 Property Owner Name(s), Address and Phone:                                   Contact Person, Name, Address, Phone Number & Fax:

                                                                         Contact E-mail address:
SIGNATURE        (Signature required is either the property owner OR the property owner’s authorized representative)

Signature                                                 Date                                   Relationship to Property Owner

Printed Name                                                                                                           Last Rev: June 2011

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