DocuSign Envelope ID: 10861DB7-D025-4919-9D2C-C7B1FD7DE9DA REV 1/5/2022 Cannabis License Application Page 54 of 68
THE CITY OF
ENVIRONMENTAL
INFORMATION O BARSTOW
AND
CHECKLIST FORM CROSSROADS OF OPPORTUNITY
(to be completed by applicant)
Date Filed: Planning Case No.
l Developen or Project Sponso
Name: sky Club HD, LLO
Address: 2588Mercantile Way, Bldg 18.
State: CA Zip: 92311
City: Barstow
2 Address of project:
2588 Mercantile Way Barstow Ca 92311
3 Assessor's Block and Lot Number: 0428-211-26-0000
4% Primary Project contact,
Phone: 909-900-3522
Name: Greg Hakopyan
Address: Email: [email protected]
2588 Mercantile Way, Bldg 18,
Barstow State: CA Zip: 92311
City:
5 list and describe any other related permitsiand other public approvals required for this project, including those required by cit tegional, state and federalagencies:
We anticipate needing a demolition permit, tenant impovement building permits, a landscape permit, minor electrical building permit, sign permits and a business license from the city. Other agencies are not expected to be party to this build.
6. Existing zoning districte Commercial
7. Proposed use of site (Project for which this form is filed):
Retail Cannabis Dispensary
PROJECT DESCRIPTION
8 Site sized 29 acres
2 Square footage approximatley 3,000 feet renovation of a 12,960 sq foot existing building 20, Number of floors of construction 1
11. Amount of off street parking provided andin ber of employees perish ft/tota Ample Parking Onsite
212 (Artach Plang)
13 Anticipated incremental development (ea phasing)
1 Phase
14 tithis a commercial project, indicate the type of project, whether neighborhood, aty or regionally oriented, square footage of sales area, andiloading faclitiess
This is a neighborhood/regional project and will have a sales floor area of about 2000 sa feet 15, if this is an industrial project, indicate the type of project, estimated, employment per shift, and loading facilitie none
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 10861DB7-D025-4919-9D2C-C7B1FD7DE9DA REV 1/5/2022 Cannabis License Application Page 55 of 68
16. 1f 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 ff the project involves a varlance, conditional use permit, or rezoring application, state this and indicate clearly why the application is required:
This project requires a Conditional Use Permit 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.
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 explosives.
V 27. Substantial change in demand for municipal service (police, fire, water, sewage, etc.).
V 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 stability, plants 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, artment houses, shops, department stores, etc.), and scale of development (height, frontage, set-back, rear yard, etc.). Atta otographs of the vicinity. Snapshots, digital or polaroid photos will be accepte NOTE: Before the Lead Agency can accept this application as complete, the applicant must consult the lists prepared pursuant to Section 65962.5 of the Government Code and submit a signed statement indicating whether the project and any alternatives are 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 knowleds and,.belief.
1/27/2022
-5D7AEA562E9C4EA...
Signature: Date:
Sky Club HD, LLC
For:
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 10861DB7-D025-4919-9D2C-C7B1FD7DE9DA 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: Sky Club HD, LLC Garnik Hakopyan
2. Address:.--
2588 Mercantile Way, Bidg 18, Barstow CA 92311
3. Phone Number: 909-900-3522
4. Address of Site (street name and number if available, and ZIP code):
aran Mercantile Way, Bldg 18, Barstow CA 92311
2588
5. Local Agency (city/county): City of Barstow/ San Bernardino County
6. Assessor's book, page, and parcel number: 0428-211-26-0000 book 139, page 3
7. Specify any list pursuant to Section 65962.5 of the Government Code:
8. Regulatory identification number:
9. Date of List:
•DocuSigned-by:
tho 1/27/2022
-
SDTAEA562E9C4EA.
Signature: Date:
Garnik Hakopyan
Sky Club HD, LLC
For: (Applicant)
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home