Dorchester County Application For Subdivision/site Plan Form
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1DORCHESTER COUNTY APPLICATION FOR SUBDIVISION/SITE PLAN
P & Z #
General Information
Subdivision/Site Plan Name:___________________ Zoning District _______________________
Tax Map _______ Block __________ Parcel __________ Lot _________ Tax Account No. _____________
New Subdivision/Site Plan
Acr. Of Total Parcel ______ Acr. In Sub/Site _____ Total No. of lots Proposed _____ Acr. Of reside, if any ___
Location (Existing road serving project site) ________________________________________________________
Road Classification of road above _________________________________________________________________
(Limited access, major collector, minor collector or local)
Plat Revision Only
Previous Plat being revised (P&Z No.) ____________ Type of Revision _________________________________
(
Lot line revision, adjoining of parcels, SRA change or other (explain)
Is this an “exempt” subdivision under 140-4? If yes check which exemption is claimed:
Adjoining parcels
Exchange of land
Agricultural purposes
Transfer for public purposes
Infrastructure
Portable Water Supply (Check One)
Sewerage Disposal (Check One)
Individual
__________
____________
Public Community ___________________________
________________________________________
(Name)
(Name)
Private Community __________________________
________________________________________
(Name)
(Name)
Shared Facility
___________
___________
Is an interior road to be constructed? ________ Name of road to be constructed __________________________
(Yes or No)
Will the owner be entering into a Road Construction Agreement?
___________
____________
Yes
No
Environmental Features
Do the following environmental features apply to this site?
100 yr. Floodplain ______________
If yes, Base flood elevation is _________ feet.
(Yes or No)
Chesapeake Bay Critical Area ___________
If yes, Critical Area Designation is _________________
(
Yes or No)
(RCA, LDA, IDA)
If designation is RCA, is this an intrafamily transfer? _____________
(
Yes or No)
Is this project subject to the Forest Conservation Act? ______________
(Yes or No)
If yes, indicate how the Act applies _____________________________________________________
(
Declaration of Intent or Forest Conservation Plan required)
Is a local agency or person using state funds making application for this subdivision/site plan? ___________
(Yes or No)
Signatures (Owner must sign)
The undersigned hereby submits to the Dorchester County Planning Commission an application for
subdivision or site plan. The owner hereby authorizes required inspections of this property.
____________________________________
__________________________________
Signature of Owner/Date
Signature of applicant or agent/date
______________________________________________________
____________________________________________________
Signature of Owner/Date
Name (Print)
______________________________________________________
____________________________________________________
Name (Print)
Address
______________________________________________________
____________________________________________________
Address
______________________________________________________
____________________________________________________
Phone No.
______________________________________________________
Phone No.
Office Use Only
Application received by _____________ Subdv./Site Plan Fee ___________ Date Paid ______________
(Staff Initials)
Forest Conservation Fee $_____________
Date Paid ______________
______________
Forest Replacement Fund $____________
Date Paid
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