Medical Marijuana Dispensary, Cultivation And Infusion Separation Verification Page 2
ADVERTISEMENT
1
2–REGISTRATION PROCESS–
A. The following must be submitted to the Planning and Development Department for separation verification:
1. Legal description of the building, suite or portion thereof where the facility is located.
2. Ownership authorization document provided.
3. Separation verification form completed.
4. Survey sealed by a registrant of the State of Arizona to show compliance with the distance requirements.
Once the property is verified the applicant has sixty (60) DAYS to provide:
1. Name(s) and location(s) of off-site cultivation or dispensary facilities.
2. Site plan showing the location or suite of the facility.
3. Obtain Use Permit approval per Section 307 of the Zoning Ordinance.
B. Verifications that have expired are NON-RENEWABLE. A new verification for the proposed use shall not be
accepted within thirty (30) days of the expiration date of the prior verification . A maximum one-time thirty (30)
day extension may be granted to the applicant by the Zoning Administrator. Request for the extension must be made
in writing and received by the Planning and Development Department prior to the expiration of the original request.
C. The undersigned hereby certifies as follows:
1. The undersigned is the owner or operator of the existing or proposed use or is authorized to file this form on
behalf of the owner or operator.
2. The owner or operator of the existing or proposed use is the owner or lessee of the property on which the use is
or will be conducted or is otherwise authorized by the property owner to file this form.
3. If the use does not presently exist, but is proposed to be established, as of the date of the filing of this form, the
proposed use complies with applicable Zoning Ordinance separation requirements.
4. There are no outstanding Zoning or Building Code violations for the proposed site.
5. The undersigned has read and understood the definitions above and agrees to comply with the requirements
established for the operation of a medical marijuana facility.
6. All information provided on this form is true and correct and to the best of his/her knowledge.
7. That the undersigned acknowledges that this form does not grant the use of a medical marijuana facility.
Printed Name
Signature
Date
FOR PLANNING AND DEVELOPMENT DEPARTMENT USE ONLY
ZA#:
Zoning Map:
CITY ZONING AUTHORITY COMPLIANCE
Registration Date
Village:
Compliance Date:
Registration Time:
Q.S.:
Name:
Zoning:
Council District::
Signature:
Upon request this publication will be made available in alternate formats including large print, Braille, audiotape or computer disk to
accommodate a person with a disability if given reasonable advance notice. Please contact Elaine Noble at voice 602-495-0256 or via
the City TTY use 7-1-1.
This and other forms can be found on our website:
Page 2 of 2
Revised 5/17/16
3
Planning & Development Department – Zoning Section – 200 W. Washington Street, 2nd Floor, Phoenix, Arizona 85003 – 602-262-7131 #6
pz
00007
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical