DocuSign Envelope ID: 04CC8CBE-5B58-47C6-A893-B1CBCD4AD9AE REV 1/5/2022 Cannabis License Application Page 54 of 68
THE CITY OF
ENVIRONMENTAL
INFORMATION BARSTOW
AND
CHECKLIST FORM CROSSROADS OF OPPORTUNITY
(to be completed by applicant)
Date Filed: Planning Case No.
1. Developer or Project Sponso
Name: Grow Organic 10, Inc
Address: 2813 Lenwood Rd, Bidg 10
Barstow State: CA Zip: 92311
City:
2. Address of project.
2813 Lenwood Rd Barstow Ca 92311
3. Assessor's Blockland Lot Number 0428-211-26-0000
4, Primary Project Contacti
Name: Edvard Sargis Babaian Phone:
747-272-7181
Address: 2813 Lenwood Rd, Bldg 10 Email: [email protected] City: Barstow State: CA Zip: 92311
85 List and describe any other related permits and other public approvals required for this project, including those required by ci regional state and federal agencies:
Local building and safety permits - State Cannabis Licenses - Department of Fish and Wildlife Lake & Streambed Alteration Agreement - State Water Control Resources Board Water Quality Protection permit
6. Existing zoning district. Commercial
7. Proposed use of site (Project for which this form is filed)..
Commercial Cannabis Activity - Dispensary - Cultivation - Manufacturing - Distribution - Non Store Front Delivery - Special Events
PROJECT DESCRIPTION
3 Site size, 1.279,793 saft / 29.38 Acres
9 Square footage 330,000
1o Number of floors of construction:
11 Amount of off street parking provided and number mployees f/tota Ample Parking on Site
12. (Attach Plans)
13 Anticipated incremental development (i.e, phasing)
1 Phase
14 if this is a commercial brofect indicate the type of project whether neighborhood, city or regionally oriented, square footage of sales area, and loading facilities
This is a neighborhood regional project and this will be a cultivation facility with no retail sales area. All products cultivated within the facility will be transferred to one of the distribution licensed facilities for further packaging and sold into the 15 minists a dustral project, hdicate the type of project, estimated employment per shift, andilading facities none
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 04CC8CBE-5B58-47C6-A893-B1CBCD4AD9AE REV 1/5/2022 Cannabis License Application Page 55 of 68 16, If thisis 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
17.11 the project involvega variance, conditional use permit or rezoning application, state this and indicate dearly why the application is required
This project requires a Conditional Use Permit as part of the City of Barstow Cannabis Licensing 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. x 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.
27. Substantial change in demand for municipal service (police, fire, water, sewage, etc.).
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, partment houses, shops, department stores, etc.), and scale of development (height, frontage, set-back, rear yard, etc.). Attac hotographs of the vicinitv. Snapshots, digital or polaroid photos will be accepted NOTE: Before the Lead Agency can accept this application as complete, the applicant must consult the lists prepared pursuant to ection 65962.5 of the Government Code and submit a signed statement indicating whether the project and any alternatives ar ocated 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 knowledgean. belief.
Edward Sargis Babaian 3/28/2022
Signature: Date:
Grow Organic 10, Inc
For:
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 04CC8CBE-5B58-47C6-A893-B1CBCD4AD9AE 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: Grow Organic 10, Inc
Edvard Sargis Babaian
2. Address: 2813 Lenwood Rd, Bldg 10 Barstow, CA 92311
3. Phone Number: 747-272-7181
4. Address of Site (street name and number if available, and ZIP code):
2813 Lenwood Rd, Bldg 10 Barstow, CA 92311
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:
*Docustgned byr
Eduard Sargis Babaian 1328/2022
-60BF5A11D51C4A1.. Date:
Signaturerow Organic 10, Inc
For: (Applicant)
220E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home