Development Applications and Regulatory Coordination
M-NCPPC 8787 Georgia Avenue, Silver Spring, MD 20910 301-495-4550, fax: 301-495-1306
Effective 9/30/2013
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APPLICATION
Forest Conservation Law Applicability for Special Exceptions
PROPERTY LOCATION
Street Address:
Subdivision: Parcel(s) # Lot #(s): Block(s):
Property Tax Identification Number: , ,
Applicant (Owner or Contract Purchaser):
Name
Street Address
City State Zip Code
Phone No. Fax No.
Total Area of Property: acres square feet
APPLICANT ATTESTS THAT THE FOLLOWING STATEMENTS APPLY TO THE SUBJECT SPECIAL EXCEPTION APPLICATION
Applicant attests that the following statements apply to the subject special exception:
n The application does not propose any clearing or grading activities on or near the special exception site.
OR, all of the following:
n The application applies to a property of less than 40,000 square feet.
n The property is not subject to a previously approved Forest Conservation Plan.
n The special exception proposal will not impact any champion tree as defined by the Montgomery County Forestry Board.
Signature of applicant (Owner or Contract Purchaser):
Signature Date
FOR STAFF USE ONLY
M-NCPPC acknowledges that the special exception for the above property:
is not subject to the Forest Conservation Law as defined in Chapter 22A of the Montgomery County Code
is exempt from the Forest Conservation Plan requirements under Section 22A-5 (q)(1) of the
Forest Conservation Law
Signature of M-NCPPC Environmental Planning staff reviewer:
Signature Date
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