REV 1/5/2022 Cannabis License Application Page 54 of 68
THE CITY OF
ENVIRONMENTAL
INFORMATION ä BARSTOW
AND
CHECKLIST FORM CROSSROADS OF OPPORTUNITY
(to be completed by applicant)
Date Filed: Planning Case No.
1. Developer or Project Sponsor:
Name: Grow Organic 12, Inc
Address: 2833 Lenwood Rd, Barstow, CA 92311
Barstow State: : CA Zip: 92311
City:
2. Address of project:
2833 Leniwood Rd, Barstow, CA 92311
3. Assessor's Block and Lot Number : 0428-211-26-0000
4. Primary Project Contact
Name: _ Phone: 818-482-0358
Address: 2833 Lenwood Rd. Barstow. CA 92311 _ Email: [email protected] City: Barstow | State: CA Zip: 92311
5. List and describe any other related permits and other public approvals required for this project, including those required by city regional, state and federal agencies:
sace but and Resources Boar later Qui nigion parent of Fish Will Lake & streambe Alteration Agreement.
6. Existing zoning district:
1. Proposed use of site (Project for which this form is filed) ommercial Cannabis Activity - Dispensary - Cultivation - Manufacturing - Distribution - Non Store Front Delivery - Special Event
PROJECT DESCRIPTION
8. Site size: 1,279,793 sqft / 29.38 Acres
9. Square footage: 330,000 suft
10. Number of floors of construction:
11. Amount of off-street parking provided and number of employees per shift/total:
Ample Parking on Site
12. (Attach Plans)
13. Anticipated incremental development (i.e., phasing):
1 Phase
14. If this is a commercial project, indicate the type of project, whether neighborhood, city or regionally oriented, square footage of sales area, and loading facilities:
This a neighborhode cion pried and bis liber cutain aily ir paral an ana. Alpres maria malia within theM
15. If this is an industrial project, indicate the type of project, estimated employment per shift, and loading facilities:
None
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home REV 1/5/2022 Cannabis License Application Page 55 of 68
16. If this is an institutional project, indicate the major function, estimated employment per shift, estimated occupancy, loading facilities, and community benefits to be derived from the project:
None
17. If the project involves a variance, conditional use permit, or rezoning application, state this and indicate clearly why the application is required:
This project requires a Conditional Use Permil as part of the City of Barstow Cannabis Licenseing process Are the following items applicable to the project or its effects? Discuss below all items checked yes (attach additional sheets as necessary).
YES NO
18. Change in existing features of any hills, or substantial alteration of ground contours.
19. Change in scenic views or vistas from existing residential areas or public lands or roads.
20. Change in pattern, scale or character of general area of project.
21. Significant amounts of solid waste or litter.
22. Change in dust, ash, smoke, fumes or odors in vicinity.
23. Change in lake, stream or ground water quality or quantity, or alteration of existing drainage patterns.
24. Substantial change in existing noise or vibration levels in the vicinity.
X 25. Site on filled land or on slope of 10 percent or more.
26. Use or disposal of potentially hazardous materials, such as toxic substances, flammables or
27. Substantial change in demand for municipal service (police, fire, water, sewage, ctc.).
28. Substantially increase fossil fuel consumption (electricity, oil, natural gas, etc.).
29. Relationship to a larger project or series of projects.
ENVIRONMENTAL SETTING
30. On a separate page, describe the project site as it exists before the project, including information on topography, soil stabllity, olants and animals, and any cultural, historical, or scenic aspects. Describe any existing structures on the site, and the use of the structures. Attach photographs of the site. Snapshots, digital or polaroid photos will be accepted.
31. On a separate page, describe the surrounding properties, including information on plants and animals and any cultural, historical, or scenic aspects. Indicate the type of land use (residential, commercial, etc.), intensity of land use (one-family, apartment houses, shops, department stores, etc.), and scale of development (height, frontage, set-back, rear yard, etc.). Attach photographs of the vicinity. Snapshots, digital or polaroid photos will be accepted.
IOTE: Before the Lead Agency can accept this application as completc, the applicant must consult the lists prepared pursuant t ection 65962.5 of the Government Code and submit a signed statement indicating whether the project and any alternatives ar located on a site which is included on any such list, and shall specify any list.
CERTIFICATION
I hereby certify that the statements furnished above and in the attached exhibits present data and information required for this Initial evaluation to the best of my ability, and that the facts, statements, and in formation presented are true and correct to the best of my knowledge and belief.
7/15/22
Signature: Date:
Grow Organic 12, Inc
For:
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home REV 1/5/2022 Cannabis License Application Page 56 of 68
HAZARDOUS WASTE AND SUBSTANCES STATEMENT
The development project and any alternatives proposed in this application are contained on one or more of the lists of hazardous waste sites and facilities compiled pursuant to Section 65962.5 of the Government Code. Accordingly, the project applicant is required to submit a signed statement which contains the following information:
1. Name of applicant: Fred Dehnoushi
2. Address: 2833 Lenwood Rd, Barstow, CA 92311
3. Phone Number: 818-974-6397
4. Address of Site (street name and number if available, and ZIP code):
2833 Lenwood Rd, Barstow, CA 92311
5. Local Agency (city/county): City of Barstow / San Bornardino County
6. Assessor's hook, page, and parcel number: 0420-211-2G-0000
7. Specify any list pursuant to Section 65962.5 of the Government Code:
8. Regulatory identification number:
9. Date of List:
7/15/02
Signature: Date:
Fred Dehnoushi
For: (Applicant)
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home