Countywide Planning Division – Environmental 1 of 5

Montgomery County Planning Department

Maryland-National Capital Park and Planning Commission Effective: July 18, 2008
8787 Georgia Avenue Phone 301.495.4540
Silver Spring, Maryland 20910-3760 www.mcparkandplanning.org/environment Fax 301.495.1303

FOREST CONSERVATION PLAN APPLICATION

Preliminary FCP Final FCP Revised Application Amendment

M-NCPPC Staff Use Only

FCP File Number ____________________
NRI/FSD Plan Number 4___________________
Preliminary/Site Plan Number ____________________
Date Application Received ____________________ Clear Form
Date Application Complete ____________________
Application Completed by ____________________
Fee (attach worksheet) ____________________
Fee Received by ____________________
An application will not be accepted for review unless all required information below and appropriate fees are provided. If an item requires more space, attach a separate sheet.

Name of Plan: _____________________________________________________________________________________

Size of property tract: ___________ Acres __________________ SF
Not within SPA
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:
On _______________________________________, _______ feet ____________ of ____________________________
Street Name (N,S,E,W etc.) Nearest Intersecting Street
Subdivision Information: (Complete either A, if located within a recorded subdivision, or B)
A. Lot __________________ Block __________________ Subdivision ___________________________________
B. Parcel _____ Liber _____ Folio _____; Parcel _____ Liber _____ Folio _____; Parcel ______ Liber _____ Folio _____

Applicant ( Owner, Owner’s Representative, or Contract Purchaser – check applicable: written verification required if not the owner)

Name

Street Address

City State Zip Code

Telephone Number ext. Fax Number E-mail

Plan Preparer (Qualifications of preparer must be included if individual has not been previously certified.)

Name

Street Address

City State Zip Code

Telephone Number ext. Fax Number E-mail

 FCP Application 2 of 5
Preliminary Forest Conservation Data
Total Tract Area: __________ acres
Dedicated or Exempted Land: __________ acres
(parkland, WSSC, agriculture, etc.)
Net Tract Area: __________ acres
Forest Retention On-site __________ acres Off-site __________ acres
Within Priority Areas __________ acres
Total Forest Clearing: __________ acres
Forest Clearing in Stream Buffer __________ acres
On-site Forest Planting Provided:
Reforestation __________ acres
Afforestation __________ acres
Within Priority Areas __________ acres
Off-site Forest Planting Provided:
Reforestation __________ acres
Afforestation __________ acres
Within Priority Areas __________ acres
Off-site Retention/Planting Locations:
Watershed for Off-site Retention: _______________________________________________
Watershed for Off-site Planting: _______________________________________________

Supplemental Information:
Previous Plan Submittals: (enter information, if applicable)
NRI/FSD Submission Name ______________________________________ File Number 4____________
Pre-Application Submission Name ______________________________________ File Number 7____________
Preliminary Plan Name ______________________________________ File Number 1____________
Sediment Control Plan Name ______________________________________ File Number SC___________

Describe the nature of the amendment or revision, if applicable. (Note: This form applies to full plan amendments) Attached

Legal restrictions on property not shown on plan, if any*

*MNCPPC does not enforce private easements or any other private legal agreements, but they should be noted as part
of the application
 FCP Application 3 of 5
Applicant hereby notifies 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).

Signature of Applicant (Owner, Owner’s Representative, or Contract Purchaser)

___________________________________________________________________________ ___________________
Signature Date

_______________________________________________________
Name (Type or Print)

Checklist
No. Engineer/ M-NCPPC
See Submission Requirements for more details about the items below:
Copies Surveyor Staff
Submitted or Waived By Accepted or Not Accepted
1. General Information
1.1 Complete application form and checklist........….….....……………… 1 Not Included
1.2 Complete fee schedule and worksheet...……................……………. 1 Not Included

2. Preliminary Forest Conservation Plan Drawing

If not submitted with a Preliminary or Site Plan, provide…………………... 2 Not Included
2.1 Scaled drawing with north arrow Not Included
2.2 Title Information Not Included
2.3 Vicinity location map Not Included
2.4 Signature of qualified preparer Not Included
2.5 Boundary outline of property tied to Maryland State Grid System Not Included
2.6 Topography Not Included
2.7 Shape and dimensions of lots, showing locations of existing
structures and improvements including paved areas Not Included
2.8. Locations and dimensions of all existing and proposed rights-of-
way, setbacks, easements, stockpile areas, and stormwater
management facilities; identify road and utility easements which
will not be improved as part of the development application Not Included
2.9 Location of building restriction lines and areas to be conserved
including floodplains, wetlands, and stream/environmental buffers Not Included
2.10 Locations and footprints of proposed structures, retaining walls,
road and parking layout, sidewalks and pathways, drainage
systems, and recreation facilities Not Included
2.11 Proposed site grading, limits of disturbance of the natural terrain,
location of forest and tree stand retention areas, and sediment
control measures Not Included
2.12 Proposed locations of afforestation and reforestation, including
acreage Not Included
2.13 Proposed tree save areas including acreage or credit requested Not Included

3. Forest Conservation Worksheet

Include on FCP Drawing…………..……………………………………….... 2 Not Included
 FCP Application 4 of 5

No. Engineer/ M-NCPPC

Copies Surveyor Staff
4. Data Table
Include on FCP Drawing……………………..………………….................. 2 Not Included
4.1 Acreage of tract Not Included
4.2 Acreage of tract remaining in agricultural use Not Included
4.3 Acreage of road and utility ROWs which will not be improved as
part of the development application Not Included
4.4 Acreage of total existing forest Not Included
4.5 Acreage of forest retention Not Included
4.6 Acreage of total forest cleared Not Included
4.7 Land use category and conservation/afforestation thresholds from
Section 22A-12(1) of the Forest Conservation Law Not Included
4.8.a.Acreage of forest retained within wetlands Not Included
4.8.b.Acreage of forest cleared within wetlands Not Included
4.8.c.Acreage of forest planted within wetlands Not Included
4.9.a.Acreage of forest retained within 100-year floodplain Not Included
4.9.b.Acreage of forest cleared within 100-year floodplain Not Included
4.9.c.Acreage of forest planted within 100-year floodplain Not Included
4.10.a.Acreage of forest retained within stream buffers Not Included
4.10.b.Acreage of forest cleared within stream buffers Not Included
4.10.c.Acreage of forest planted within stream buffers Not Included
4.11.a. Acreage of forest retained within priority areas Not Included
4.11.b. Acreage of forest cleared within priority areas Not Included
4.11.a. Acreage of forest planted within priority areas Not Included
4.12 Linear feet and average width of stream buffer provided on each
side of streams Not Included

5. Final Forest Conservation Plan

In addition to items 2, 3, and 4 above include on FCP Drawing………... 2
5.1 Final site grading plans which include building locations and
footprints, retaining walls, road and parking layout, sidewalks and
pathways, and recreation facilities. Not Included
5.2 Limits of disturbance lines which reflects the limits of all clearing
and grading of the tract, and location of sediment and erosion
control devices Not Included
5.3 Survey of trees 24 inches and greater at 4.5 feet over ground for 50
feet on either side of the LOD, and delineation of their critical root
zones. Not Included
5.4 Retention areas including forest, tree stands and other individual
trees to be saved, including acreage Not Included
5.5 Location and acreage to be planted Not Included
5.6 Analysis of suitability for the planting site and pre-planting
measures Not Included
5.7 List of trees and shrubs to be planted, including sizes and quantities Not Included
5.8 Planting area protection measures (at a minimum, fencing and deer
control) Not Included
5.9 Inspection schedule Not Included
5.10 Long-term maintenance plan Not Included
5.11 Financial security calculation Not Included
5.12 Maintenance and management agreement Not Included
 FCP Application 5 of 5

The plan preparer hereby certifies that all required information for the submission of forest conservation 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 Plan Preparer

___________________________________________________________________________ ___________________
Signature Date

_______________________________________________________
Name (Type or Print)