EASEMENT APPLICATION

LPT EASEMENT APPLICATION

Owner's Name ________________________________________________________________________

Address _______________________________________________________________________________

Phone # _________________________________Cell Phone #____________________________________

Email _________________________________________________________________________________

Property Address (if different from owners address)____________________________________________

I - Information Relating to the Development Potential of the Property

total acres ________________ number of parcels _________________

number and type of dwelling (principal residence, guest house, tenant house, etc.) on each parcel_______________________________________________________________________________

____________________________________________________________________________________

Do you wish to retain any of those development rights to build a home in the future______ yes ______ no

please note - the value of the easement will be significantly reduced by any development rights retained

Is the land currently subject to any easement restrictions (eg pipeline, transmission tower, CREP, historic or

environmental protection easements)? __________ yes ____________no

If yes, please describe the easement in detail _________________________________________________

______________________________________________________________________________________

II - Information Relating to the Land Features, Management and Resource Values

Approximately what percentage of the site is currently used for crop and/or animal production

(includes pasture land) ________________

Is there a Soil Conservation and Water Quality (SCWQ) Plan currently in effect? ______ yes _____no

If there is a SCWQ please attach a copy. A SCWQ will need to be prepared for this property if an easement is acquired.

Are there significant farm buildings, or farm infrastructure on the site (corn cribs, implement shed, dairy barn, etc...)?

_______yes ________no

If yes, please list_____________________________________________________________________

__________________________________________________________________________________

Approximately how many acres of the site are currently or potentially commercial woodland? _______________

Is the Property currently subject to a Forest Conservation Management Agreement, or Forest Resource Management Plan?

__________ yes ____________ no

Please note when the Property contains more than 5 acres of contiguous Woodland a Forest Stewardship Plan is required.

Is the property visible from a public road? _________yes_____________ no

Name of road or roads ______________________________________________________

III - Natural Resource Characteristics of the Site

Approximate linear feet of streams located on the property ________________ feet

please note - as a condition of the easement you will be expected to maintain or establish buffers along the edge of all streams.

Approved stream crossings will be allowed.

Approximate acres of wetland on the property __________________ acres

Are you willing to prohibit livestock from streams on your property, other than at approved stream crossings?

__________ yes __________ no

If you are currently prohibiting livestock from all or a part of the streams on you property please indicate the a

pproximate number of current feet of fencing that protect streams. ________________ feet.

V - Historic Features

Is your property located within a National Historic District or Village ________ yes ___________no

If yes, please name ________________________________________.

Does your property include a contributing structure to a National Historic District ______yes _____no

If yes, please name ________________________________________.

Is your property a County, State of Federal Historic Landmark? _________yes __________no

Is your property a Bicentennial or Century Farm? ___________ yes ____________no

VI - Special Features

Is this an owner - operated farm? ________ yes _____________ no

Are there any specialty or unique farming operations? ___________ yes ____________no

If yes, what are the operations? _______________________________________________

Is there any imminent development threat? ____________ yes _______________no

if yes, please describe_______________ _________________________________________________

__________________________________________________________________________________

VII - Additional Information

Was the property ever used for any non-farm operations? _______ yes ___________no

If yes, please describe _________________________________________________________________

Do you have plans to locate any additional structures on the property? ______ yes _______ no

If yes, please describe and indicate proposed location________________________________________

______________________________________________________________________________________

Please note that you may be required to obtain approval from the Land Preservation Trust prior to building any major new structures on the property.

Names and addresses of any holders of mortgages, liens, deeds of trust, or other encumbrances on the property: please note that any and all lien (mortgage) holders will be required to subordinate their interests to an easement. _______________________________________________________________

___________________________________________________________________________________

Have you completed an environmental assessment on the property for any reason? _____ yes _______no

If yes, please attach. If such an assessment has not been completed, please note that one will be conducted prior to easement settlement.

Other information regarding your property that you feel would be helpful in evaluating your application

__________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

I hereby certify that the above information is correct to the best of my knowledge and agree to a site visit and verification of all information regarding my property by sponsor organization members, staff, or representatives.

Owner's Signature (s) ________________________________ Date __________________

________________________________ __________________

_________________________________ __________________

Please submit completed applications to:

Ann Jones

2921 Greenway Drive

Ellicott City, MD 21042