Acquisition Application and Project Agreement (Cont.)

Maryland Department of Natural Resources

Program Open Space

Acquisition Application and Project Agreement

Shaded Areas For State Use Only. / POS PROJECT #
1. / PROJECT TITLE:
2. / APPLICANT: / APPLICANT’S FEDERAL ID #:
(County/Municipality)
3. / LEGISLATIVE DISTRICT: / LAST POS GRANT ISSUED ON THIS SITE #:
4. / PROJECT LOCATION: Street Address:
City/Town: / Zip Code:
County Tax Map # / Grid / Parcel # / ADC Road Map Edition # / Map # / Grid Ltr / Grid #
5. / PROJECT DESCRIPTION: Descriptions are written into the agenda item, which is presented to the Maryland Board of Public Works for approval. Please explain the proposed acquisition and be specific. Why is it being done and how does it relate to local recreation needs? Is it a new acquisition or does it build upon an existing facility? Provide all of the information that you feel is necessary to explain and justify the project and to convince the approving agencies that it is a worthwhile acquisition. Attach a separate sheet, if necessary.
6. / DESCRIPTION OF LAND TO BE ACQUIRED:
Acres to be acquired with this acquisition: / Ac.
Existing park acreage: / Ac. / Planned ultimate acreage: / Ac.
This is a new area: / Or, an addition to an existing area / Nearest town or community served:
This property is: / Unimproved / Or Improved
If improved, list all current improvements: identify size, condition and future use of each improvement, if known:
How many acres are: / Wooded / Ac. / Agricultural / Ac. / Floodplain / Ac.
In the Critical Area / Ac. / (describe):
Non-Tidal Wetlands / Ac. / (describe):
The topography is flat, steep, sloping or other (describe):
Subdivided? / No Yes / If yes, # of lots / Average size of lots
Explain Zoning:
Is the property currently being utilized at its highest and best use? / Yes No
Current Land Use:
Highest and Best Use: / Developable potential - # of lots:
Utilities available: / Water / Sewer / Electric / Gas / Phone
Road Frontage: / Ft. / Paved / Unpaved
Environmental Hazards: / Yes No / If there are any hazards, list them and identify how they will be addressed:
7. / POTENTIAL CONFLICTS: Describe how you will address any potential conflicting uses or any possible “noncompatible” uses being planned within the next ten years, which might require a Land-Use Conversion; e.g., road widening, etc.
8. / BENEFITS DERIVED FROM THIS ACQUISITION:
9. / INFRASTRUCTURE: Will the development planned for this site result in an increased demand on existing infrastructure (roads, utilities, etc.)? Yes No If yes, how will this be addressed?
10. / HOW IS THIS PROJECT CONSISTENT WITH THE COUNTY’S LAND PRESERVATION, PARKS AND RECREATION PLAN?
11. / WHAT, IF ANYTHING, MAKES THIS PROJECT UNIQUE?
12. / LAND VALUES:
$ / $ / / / Acre
(Appraiser) / (Date of Appraisal)
$ / $ / / / Acre
(Appraiser) / (Date of Appraisal)
13. / APPRAISAL EVALUATION:
a. / Spread between appraisals: / %
If the value of the high appraisal is more than 20% greater than the low appraisal, please explain:
b. / Average of appraisals: / $
Is the cost for land and improvements equal to the average of the appraisals? Yes No
If no, please explain:
c. / Appraisal value relative to area: Reasonable High Low If high or low, please explain:
d. / Are appraisals more than 12 months old? Yes No If yes, please explain:
14. / PROJECT COSTS:
Total Costs / POS Assistance
a. / Land Cost: / $ / $
b. / Cost of Improvements: / $ / $
c. / Incidental Costs: / $ / $
Itemize below (appraisals, title work, surveys, etc.)
$
$
$
$
$
d. / Total Project Cost: / $
e. / POS Funding Requested: / $
15. / SELLER’S NAME: / Owned Since:
16. / TITLE WILL BE HELD BY:
(Name of County/City, Department)
In Fee Simple? Yes No If not, please describe:
17. / LOCAL PROJECT COORDINATOR:
(Print Name) / (Print Title) / (E-mail Address)
(Mailing Address) / (City) / (State) / (Zip) / (Telephone Number)
18. / PROJECT PERIOD: / From: / (Date of Letter of Acknowledgement/Concurrence)
To: / (Estimated Date of Completion)
19. / LOCAL GOVERNMENT AUTHORIZATION:
As the authorized representative of this Political Subdivision, I read the terms of the “Project Agreement and General Conditions” of the Program Open Space (POS) Grants Manual and I agree to perform all work in accordance with the Manual, POS Law and Regulations, and with the attachments included herewith and made a part thereof.
(Signature) / (Print Name) / (Print Title) / (Date)
PROGRAM ADMINISTRATIVE REVIEW:
20. / ON-SITE INSPECTION / DATE / BY
21. / DEPARTMENT OF NATURAL RESOURCES – PROGRAM OPEN SPACE APPROVAL:
(Signature) / (BPW Approval Date) / (Agenda Item No.)

Revised 01/15