Street Address, City, State, Zip Code
Subdivision Lot & Parcel # and/or Tax Map Designation
(name, address and approval if applicable)
Please note whether lot of record delineates the Resource Protection Area (RPA) per the Chesapeake Bay Preservation Area requirements.
*please notate whether RPA/RMA exists on site
May be submitted as a hard copy to the Building Official
This field is not part of the form submission.
* indicates a required field