ࡱ> _ objbj vbb3#NN$P6l/ktF\lleeefjhjhjhjhjhjhj$lUoVj]~%@e~~jNNlj$$$~vNRlfj$~fj$$]"bwVdX^_4Rjj0/k_o~ohbobeY$eeejjT#eee/k~~~~oeeeeeeeee :   COUNTY___________________________________ TOWNSHIP_________________________________ APPLICANT LAST NAME____________________ APPLICANT FIRST NAME____________________ ENERGY GENERATION SYSTEM TYPE: o SOLAR % o WIND % Farmland Preservation Program Application for Energy Generation Facilities on Existing Buildings or Structures on Preserved Farmland N.J.S.A. 4:1C-32.4 Please be sure to provide all requested information and documentation in this application form. Completed applications should be submitted to the State Agriculture Development Committee, P.O. Box 330, Trenton, NJ 08625-0330. a. APPLICANT INFORMATION Duplicate this sheet as necessary to INDICATE ALL APPLICATION PARTICIPANTS. Please number each DUPLICATED page for THIS SECTION (e.g., Page 1 of 3). Enter information for each related party applying for approval of energy generation (landowner of record and/or installer). ________________________________________________________________________ Applicant Name and Affiliation (if not Landowner of Record) ________________________________________________________________________ Address ________________________________________________________________________ City: _______________________ State:______________ Zip Code: _____________ Contact Person: _________________________________________________________ Phone (business or home): __________________________ Fax: _________________ Phone (other): ___________________________________________________________ _______________________________________________________________________ Landowner of Record _______________________________________________________________________ Address: _______________________________________________________________________ City: ___________________________ State: ____________ Zip Code: __________ Phone (business or home): _______________________ Fax: ____________________ Phone (other): ___________________________________________________________ -2- B. BLOCK, LOT & ACREAGE OF FARM NOTE: For the purposes of this application, farm refers to all land under the Farmland Preservation Program Deed of Easement (Easement) and all exception areas not covered by the Easement. Duplicate this sheet as necessary to INDICATE each lot and its acreage separately. Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ TOTAL ACRES: ______________________ ACREAGE BASED ON: Tax map acres o % Survey acres %n -3- C. LOCATION WHERE ENERGY FACILITY WILL BE CONSTRUCTED: (Check appropriate box(es) to indicate whether the facility will be located on the preserved land or an exception area): Block: _____ Lot: ______ Acres: ______ Preserved land o Exception Area: Severable % o Non-Severable %o Block: _____ Lot: ______ Acres: ______ Preserved land o Exception Area: Severable % Non-Severable % o Block: _____ Lot: ______ Acres: ______ Preserved land o Exception Area: Severable % o Non-Severable % o Block: _____ Lot: ______ Acres: ______ Preserved land o Exception Area: Severable % Non-Severable %o D. TYPE OF ENERGY SYSTEM TO BE INSTALLED AND RATED CAPACITY Solar Photovoltaic o % Photothermal o % Wind o % Energy generation capacity of system -- kilowatts or megawatts (AC  alternating current) __________________ E. FARMS ENERGY DEMAND FOR THE PREVIOUS CALENDAR YEAR (Note: For purposes of this application, demand means actual energy use.) ________________________ kilowatts -4- F. GENERAL APPLICATION INFORMATION 1. Please provide the following information: a. Copy of current recorded deed of ownership. (Available from the office of the county clerk if not in possession of landowner) ATTACH AS SCHEDULE A b. Farmland Assessment form for the most recent tax year. ATTACH AS SCHEDULE B c. Digital photographs of the structure(s) on which the energy generation system is proposed, from front, side and rear (hard copy and digital copy). ATTACH AS SCHEDULE C d. Copy of industry technical bulletin describing the equipment. ATTACH AS SCHEDULE D e. Copies of 12 months of utility bills for previous calendar year (or copy of most recent bill if it contains the previous 12 months usage information, in which case only this one bill is required). ATTACH AS SCHEDULE E 2. Identify and describe any solar, wind or biomass energy generation already in existence on the premises or any portion of the farm (including severable or non-severable exception areas) at the time of this application, including the type of system, rated energy generation capacity of the system, date of installation and how the energy is used today. ATTACH AS SCHEDULE F 3. Set forth the following in complete detail: Identification of the buildings/structures where the energy facilities, structures or equipment will be located, including use, dimensions (size, width, height) and date of construction. Dimensions (number, size, width and height) of energy facilities, structures and equipment proposed to be installed. The rated capacity of the energy facilities, structures and equipment. Any infrastructure (pipes, wires, improvements, etc.) necessary to accommodate the proposed energy system. ATTACH AS SCHEDULE G -5- 4. Explain how the energy facilities, structures or equipment will affect the use of the land for agricultural or horticultural production. ATTACH AS SCHEDULE H. 5. Explain who will own the energy facilities, structures or equipment. If the landowner will not own them upon installation, provide a copy of the lease/agreement detailing how the property owner will acquire ownership interest in the facilities, structures or equipment over time. ATTACH AS SCHEDULE I 6. Explain how the energy generated from the facilities, structures or equipment will be used to provide power or heat to the farm, either directly or indirectly, or will reduce, through net metering or similar programs and systems, energy costs on the farm. ATTACH AS SCHEDULE J 7. Explain if the energy generation system is for the purpose of providing power or heat to service a nonagricultural use on the farm. If so, describe the nonagricultural use and where it is located (including block/lot), and provide evidence of the energy demand of the non-agricultural use. ATTACH AS SCHEDULE K 8. Explain how the amount of acreage devoted to the proposed energy facility meets the 1:5 acre requirement for farmland assessment, i.e., the 1:5 ratio for acreage in energy generation vs. acreage in agricultural/horticultural operations. ATTACH AS SCHEDULE L Explain whether the installation and operation of the energy facilities, structures or equipment will require the conveyance of an easement or other interest in the premises. If such an easement or other interest is required, provide copies of the proposed conveyance document(s), a location map and/or a survey. ATTACH AS SCHEDULE M. Explain whether the energy facility will result in any new impervious cover (placement of materials or structures on the ground). If yes, please explain in detail. ATTACH AS SCHEDULE N -6- G. 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