An application will not be accepted for review unless all required information and fees are provided.
If an item requires more space, attach a separate sheet.
Proposed Subdivision Name: ___________________________________________Acres ________Sq. Ft.__________
200 scale Base Map #_________ Tax Map #_________ Special Protection Area_________________________________
Property Tax Account Number(s) associated with the plan (8 digits)
A. _______________ B. _______________ C. _______________ D. _______________ E. _______________
F. _______________ G. _______________ H. _______________ I. _______________ J. _______________
Location: (Complete either A or B)
A. On ____________________________________, _______ feet ____________ of ___________________________
Street Name (N,S,E,W etc.) Nearest Intersecting Street
B. ________ quadrant, intersection of ________________________________ and _____________________________
(N,S,E,W etc.) Street Name Street Name
Subdivision Information: (Complete either A, if located within a recorded subdivision, or B)
C. Lot __________________ Block __________________ Subdivision ___________________________________
D. Parcel _____ Liber _____ Folio _____; Parcel _____ Liber _____ Folio _____; Parcel ______ Liber _____ Folio ____
Applicant( Owner, Owners Representative, or Contract Purchaser check applicable; written verification required if not the owner.)
Name Contact Person
Street Address
City State Zip Code
Telephone Number ext. Fax Number E-mail
Owner (If Applicant is a representative or contract purchaser, list owner here)
Name Contact Person
Street Address
City State Zip Code
Telephone Number ext. Fax Number E-mail
Development Review Division
Montgomery County Planning Department
Maryland-National Capital Park and Planning Commission
1 of 4
Effective: April 2, 2008
8787 Georgia Avenue
Phone 301.495.4595
Silver Spring, Maryland 20910-3760 www.montgomeryplanning.org Fax 301.495.1306 F a x 3 01.4 9 5.13 0 6
PRE-APPLICATION
Initial Application Final Application
M-NCPPC Staff Use Only
File Number
Date Application Received
NRI/FSD File No., if applicable
7____________________
____________________
4____________________
Fee (attach worksheet)
Fee Received by
DRC Meeting Date
MCPB Hearing Date
____________________
____________________
____________________
____________________
Not within SPA
Clear Form
Pre-Application 2 of 4
Engineer or Surveyor (if applicable)
Name Contact Person
Street Address
City State Zip Code
Telephone Number ext. Fax Number E-mail
Attorney
Name Contact Person
Street Address
City State Zip Code
Telephone Number ext. Fax Number E-mail
Development Information: (See attached Submission Requirements, section 4)
Method of Development: Standard Cluster MPDU TDRs _____ Other __________________
Zoning
Overlay
Zone
Acres
Develop-
ment Type
Code
Existing/
Previously
Approved
Residl du/
Comml sf
Retained
Residl du/
Comml sf
Proposed
Residl du/
Comml sf
*
MPDU
Other
Affordable
Housing
# of
Lots
# of
Out-
lots
Total plan acres
Total
Residl
Total
Comml
* Maximum number of dwelling units allowed by zoning
Areas Dedicated to Public Use:
Road ROWs Other ROWs Schools Parks Other Total
Supplementary Information:
Are you requesting a hearing by the Planning Board? Yes No To be determined at DRC
Are you requesting alternative review procedures for preapplication plan submission? Yes No
(50-33A, see Submission Requirements Section 2.1(f))
Are there any legal restrictions applicable to this property other than those shown on this plan?* Yes No
If yes, please describe (attach supplemental information, if needed):
*NOTE: MNCPPC does not enforce private easements or any other private legal agreements, but they should be noted in
the application.
0.00 0 0 0 0 0 0 0 0
0 0 0 0 0
0.00
Pre-Application 3 of 4
Previous Plan Submittals: (enter file numbers, if applicable)
Special Exception S- __________
Local Map Amendment/
Zoning case
G- ___________
Development
Plan Amendment
DPA_________
Pre-preliminary plan 7- __________ Project plan 9- ___________
Preliminary plan 1- __________ Site plan 8- ___________
If application includes any previously recorded lots, enter M-NCPPC record plat book & page: __________ - ________
Is this pre-preliminary submitted in anticipation of future submittal of concurrent applications? Yes No
If yes, list the type of applications:
Has the applicant had any pre-submission meetings with M-NCPPC staff? Yes No
Name of Staff: ______________________________________Date of meeting(s): _________________ (Submit minutes)
Is the property in the Locational Atlas and Index of Historic Sites? Yes No
Is the property in the Master Plan for Historic Preservation? Yes No
Is the property in an incorporated municipality? Yes, ___________________________________________ No
Is the property in a special taxing district? Yes, ___________________________________________ No
Existing Sewer and Water Categories:
Existing Service Category: Sewer ______ Water ______ Pending Service Category: Sewer ______ Water ______
Proposed Sanitary Systems: Public Water Public Sewer Well Septic
Are you requesting either advice, or action regarding a waiver or variance of any zoning and/or subdivision standards?
Yes No (If yes, application must include a Statement of Justification)
Applicant hereby certifies that he/she is the sole owner of the subject property, is otherwise legally authorized to represent the
owner(s) (written verification provided), or is a contract purchaser authorized to submit this application by the property owner (written
verification provided). Applicant hereby acknowledges that the 60-day time allotted for review by the Planning Board, as set forth in
Section 50-35(f) of the Subdivision Regulation, will not commence until final plan drawings and all supporting information necessary for
a decision on the subject application is provided to the Montgomery County Department of Planning so that it can be referred to the
appropriate agencies for final comment.
Signature of Applicant (Owner, Owners Representative or Contract Purchaser)
_______________________________________________________ _____________________
Signature Date
_______________________________________________________
Name (Type or Print)
Pre-Application 4 of 4
Checklist
See Submission Requirements for more details about the items below:
Initial Applications: submit only 2 copies of relevant items below
No.
Copies
Engineer/
Surveyor
M-NCPPC
Staff
1. General Information
1.1 Complete application form and checklist.................
1
Submitted or Waived By Accepted or Not Accepted
1.2 Complete fee schedule and worksheet ................... 1
1.3 Approved development plan, special exception, project plan application
numbers and opinion, if applicable.. 3
1.4 Notice List prepared in conformance with the Manual of Development
Review Procedures on printer labels and paper copy of labels..
2 sets of
labels & 1
paper copy
1.5 Certificate of Compliance attesting that the application conforms to all
applicable federal, state and local laws and regulations... 2
2. Pre-Application Concept Plan Submission
2.1 Concept drawings (folded copies).. 40
2.2 Statement identifying the nature of the application and the issues to be
addressed by staff and/or the Planning Board 20
2.3 PDF image of concept drawing and other approved plans ....
1
3. Supporting Functional Information/Drawings (May be submitted with any
Pre-Application Submission, but must be submitted in the circumstances
noted):
3.1 Supporting information for proposed lots using septic systems and wells:
3.1.1 Details for proposed wells and septic per section 3.1 of the Submission
Requirements must be shown on the concept plan ..
3
3.1.2 Proposed Natural Resources Inventory/Forest Stand Delineation
(NRI/FSD)... 8
3.2. Proposed Lots in the RDT Zone:
3.2.1 In the RDT Zone, a map showing prime agricultural soils and existing
farm fields........................ 6
3.3 Proposed Resubdivision:
3.3.1 For a proposed residential resubdivision, existing lot layout with
delineation of neighborhood with associated data table demonstrating
compliance with the resubdivision criteria contained in Section 50-29(b)
of the Subdivision Regulations................................................................ 2
3.4.0 If seeking future concurrent Preliminary/Site Plan review:
3.4.1 Approved Natural Resources Inventory/Forest Stand
Delineation............... 8
3.4.2 Traffic impact study or statement................................ 8
3.4.3 Proposed Stormwater Management Concept Plan..... 10
3.4.4 Existing Features on Adjoining Properties........... 2
3.5 Statement of Justification to support approval of the subject application
and for waiver(s) or variance of zoning, subdivision or road code
requirements necessary for plan to be approved, if any 8
3.6 Legal Restrictions Information . 2
The engineer, surveyor or plan preparer hereby certifies that all required information for the submission of a pre-application concept
plan has been included in this application, and that to the best of his/her knowledge, information, and reasonable belief, the information
and data are accurate.
Signature of Engineer, Surveyor or Plan Preparer (check applicable)
______________________________________________________ ______________________
Signature Date
______________________________________________________
Name (Type or Print)
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