Fillable PROCEDURE AND APPLICATION FOR A PROPOSED SPECIAL USE (Pinal County Government)

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PROCEDURE AND APPLICATION FOR A PROPOSED SPECIAL USE (Pinal County Government)

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Louis Andersen
County Manager
COMMUNITY DEVELOPMENT
Planning Division
31 North Pinal Street, Building F, PO Box 2973, Florence, AZ 85132 T 520-866-6442 FREE 888-431-1311 F 520-866-6530
www.pinalcountyaz.gov
PROCEDURE AND APPLICATION FOR A PROPOSED SPECIAL USE PERMIT (SUP)
MEDICAL MARIJUANA FOOD ESTABLISHMENT
A. Attend a Pre-Application meeting with the Planning Department and affected County agencies.
B. File an application and all required supporting documentation for a Special Use Permit. Please use the
attached application forms.
C. ***Public hearing before the Planning Commission with Commission recommendation to the Board of
Supervisors. Time frame is approximately 12 weeks from application acceptance by the Planning
Department.
D. ***Public hearing, (approximately 4 to 5 weeks after Planning Commission hearing), before the Board
of Supervisors.
E. Submit one copy of the application and all supporting documents and one digital copy on a jump drive
or CD.
F. An application checklist is located at the end of this application
FEE SCHEDULE
Submit the following fees made payable to Pinal County in accordance with Section [2.151.010(I)(2)a] of the
PCDSC:
A. 499 or less mail outs = $500.00
B. 500 or more mail outs = $750.00
*** Time frames are approximate and apply to applications for facilities located in constructed buildings only.
Applications needing Comprehensive Plan Amendments, Rezoning, PAD amendments or Site Plans that are
required to go through the “Site Plan Approval” process are not subject to these time frames.
Louis Andersen
County Manager
COMMUNITY DEVELOPMENT
Planning Division
31 North Pinal Street, Building F, PO Box 2973, Florence, AZ 85132 T 520-866-6442 FREE 888-431-1311 F 520-866-6530
www.pinalcountyaz.gov
APPLICATION FOR A SPECIAL USE PERMIT FOR A MEDICAL MARIJUANA FOOD ESTABLISHMENT IN AN
UNINCORPORATED AREA OF PINAL COUNTY, ARIZONA
(all applications must be typed or written in ink)
Special Use Permit & Property Information:
(feel free to include answers and “Supporting Information” to these questions in a Supplementary Narrative, when doing so write
see narrative on the space provided)
1. Date of Pre-application Meeting: 2. Pre-application Number: Z-PA-
3. The legal description of the property:
4. Tax Assessor Parcel Number(s): 5. Current Zoning:
6. Parcel size:
7. The existing use of the property is as follows:
8. The exact use proposed under this request:
9. Is the property located within three (3) miles of an incorporated community? If yes, which ones?
10. Is an annexation into a municipality currently in progress? If yes which one?
11. Is there a zoning or building violation on the property for which the owner has been cited?
If yes, Zoning/Building Violation Number:
12. Discuss any recent changes in the area that would support your application i.e.: zone change(s),
subdivision approval, Planned Area Development (PAD), utility or street improvements, adopted
Comprehensive/Area Plan(s) or similar changes and why this proposed use is needed and necessary at this
time:
INV#: AMT: DATE: CASE: Xref:
Version 4/18 Page | 2
Supporting Information for a Medical Marijuana Food Establishment:
1. What is the legal name of the Medical Marijuana Food Establishment?
2. Is the proposed Food Establishment located on property zoned CB-2, CB-2/PAD, C-3 or C-3/PAD?
YES NO
3. Is the medical marijuana food establishment immediately adjacent to a medical marijuana dispensary
or a medical marijuana dispensary off-site cultivation location? YES NO
4. Is the Food Establishment setback a minimum of 1,500 feet from schools, community service agency,
activity facility and or activity where children may be enrolled, measured from the parcel boundaries?
YES NO
5. Is the proposed Food Establishment dispensary setback a minimum of 1,500 feet from a childcare
center, library or public park, church, residential substance abuse diagnostic and treatment facility or
other drug or alcohol rehabilitation facility measured from the parcel boundaries? YES NO
6. Does the proposed Food Establishment have a drive-thru service or outdoor seating areas?
YES NO
7. Do you understand that if a condition is violated, that there is a public process by which your permit
may be revoked and declared null and void? YES NO
8. Does the proposed dispensary have a secure storage area for the storage of medical marijuana of less
than 400 square feet?
YES NO
9. Have you discussed possible conditions that may be placed on the permit with the Planning
Department? YES NO
10. Do you understand that distribution or sales of medical marijuana edible food products which are
infused with medical marijuana occur at a medical marijuana food establishment, other than to a
medical marijuana dispensary is prohibited? YES NO
11. Do you understand that the Pinal County Board of Supervisors may include any conditions it finds
necessary to conserve and promote public health safety, convenience and general welfare?
YES NO
12. Please indicate the dispensary or off site cultivation facilities you are affiliated with
13. What is the amount of traffic to be generated? (# of trips/day, deliveries/week).
,Show ingress/egress on the site plan.
14. How many parking spaces are to be provided (employees and customers).
Indicate these parking spaces on the site plan.
Version 4/18 Page | 3
15. Is there a potential for excessive noise (I.E.; children, machinery) or the production of smoke, fumes,
dust or glare with this proposed land use? If yes, how will you alleviate these problems for your
neighbors?
16. What type of landscaping are you proposing to screen this use from your neighbors?
. Indicate the landscaping on your site plan.
17. What type of signage are you proposing for the activity? Where will the signs be located, show the
locations of signs on your site plan.
18. If the proposed land use involves any type of manufacturing or production process, provide a short
synopsis of the processes utilizing diagrams, flowcharts and/or a short narrative.
19. Explain how the appearance and operation of the proposed land use will maintain the integrity and
character of the zone in which the Special Use Permit is requested.
Version 4/18 Page | 4
I certify the information included in this application is accurate, to the best of my knowledge. I have read
the application and I have included the information, as requested. I understand if the information
submitted is incomplete, this application cannot be processed.
Name of Applicant Address
Signature of Applicant E-Mail Address Phone Number
Name of Agent/Representative Address
Signature of Agent/Representative E-Mail Address Phone Number
The Agent/Representative has the authority to act on behalf of the landowner/applicant, which includes
agreeing to stipulations. The agent will be the contact person for Planning staff and must be present at all
hearings. Please use attached Agency Authorization form, if applicable.
Name of Landowner Address
Signature of Landowner E-Mail Address Phone Number
If landowner is not the applicant, then applicant must submit a signed notarized consent form from the
landowner with this application. Please use attached Consent to Permit form, if applicable.
Version 4/18 Page | 5
Application Checklist:
Submit a detailed site plan, at least 8½ X 11, but not larger than 11” X 17”. The site plan must include
the following:
o Size and shape of parcel; property dimensions; north arrow
o Adjacent streets; rights-of-way, easements and setbacks; indicate size; purpose and whether
public or private
o Location, size and use of all existing and proposed buildings; show setbacks from property
boundary lines and between structures
o Driveways and parking areas, show access, dimensions and surface material
o Existing and proposed utilities, show location of lines, size and serving company
o Any other information as may be applicable – landscaping, natural features i.e.: washes,
excavation sites, etc.
Submit the “Supporting Information” sheet (if applicable) and/or the “Submittal Checklist” for the
requested action. Forms are in this packet.
Submit a list of all property owners within 1000’ of the subject property boundary showing name,
mailing address and tax parcel numbers. This list must be obtained within the 30 days prior to
application submission.
Submit a map of the area with the 1000’ boundary shown. (A Tax Assessor Parcel Map is acceptable).
Submit the non-refundable filing fee according to the fee schedule shown on page 1 of the application.
(The application is not considered filed until the fees are paid.)
Submit a CD or Jump Drive which contains a copy of the application and narrative in PDF format.
A floor plan showing the location, dimensions and type of security measures demonstrating that the
medical marijuana establishment will meet the definition of enclosed locked facility contained in
A.R.S.§36-2801(6) and will be conducted completely within an enclosed, locked building, if applicable.
A copy of the facilities operating procedures adopted in compliance with A.R.S. §36-2804(B)(1)(c).
Hold a neighborhood/community meeting prior to application submittal:
o Notify all property owners within 1200’
o Hold the meeting within 5 miles of the subject property
o Hold the meeting between 5:00pm and 9:00pm
Include neighborhood Public participation information with the application:
o Copy of Notice of Neighborhood/Community Meeting
o List of property owners notified
o Meeting Minutes
o Attendance sign-in sheet with names & addresses
Install Broadcast Notification Sign(s) on the site in conformance with the information shown in this
application.
Please feel free to compile all information into a separate Narrative
Please be aware that earth fissure maps are available online from the Arizona State Geologic Survey.
Version 4/18 Page | 6
PROPERTY OWNERSHIP LIST
(required for filing all applications)
Instructions: Print Name, Address, City, State, Zip Code and Tax Parcel Number for each property owner
within 1000 feet of the subject parcel boundary. Feel free to attach a separate list if generated digitally. Please
see “How to use the Buffer Tool” on our FAQ’s page if you are generating the list.
Parcel No.: Parcel No.:
Name: Name:
Address: Address:
City/ST/Zip: City/ST/Zip:
Parcel No.: Parcel No.:
Name: Name:
Address: Address:
City/ST/Zip: City/ST/Zip:
Parcel No.: Parcel No.:
Name: Name:
Address: Address:
City/ST/Zip: City/ST/Zip:
Parcel No.: Parcel No.:
Name: Name:
Address: Address:
City/ST/Zip: City/ST/Zip:
Parcel No.: Parcel No.:
Name: Name:
Address: Address:
City/ST/Zip: City/ST/Zip:
I hereby verify that the name list above was obtained on the day of , 20 , at the
office of and is accurate and complete to the best of my knowledge.
(Source of Information)
On this day of , 201 , before me personally appeared
(name of signor)
Signature Date
State of
)ss. (SEAL)
County of
My Commission Expires____________
Signature of Notary Public
Version 4/18 Page | 7
AGENCY AUTHORIZATION
(To be completed by all landowners who do not represent themselves. Instructions for completing required information are in bold
and brackets below lines. If applicant is a company, corporation, partnership, joint venture, trustee, etc., please use the corporate
signature block and have the notary fill in the notarization section for corporations not individuals and cannot be submitted digitally)
TO: Pinal County Community Development
P.O. Box 2973
Florence, AZ 85132
__________________________________________________________________________________________
[Insert Name -- If a Corporation, Partnership or Association, Include State of Incorporation]
hereinafter referred to as “Owner,” is/are the owner(s) of __________________________acres located at
___________________________________________________________________, and further identified
[Insert Address of Property]
as assessor parcel number _____________________________________and legally described as follows:
[Insert Parcel Number]
[Insert Legal Description Here OR Attach as Exhibit A]
Said property is hereinafter referred to as the “Property.”
Owner hereby appoints __________________________________________________________________
[Insert Agent’s Name. If the Agent Is a Company, Insert Company Name Only]
hereinafter referred to as “Agent,” to act on Owner’s behalf in relation to the Property in obtaining approval
from Pinal County for a minor land division and to file applications and make the necessary submittals for such
approvals.
[Individual PROPERTY OWNER signature block and acknowledgment.
DO NOT SIGN HERE IF SIGNING AS AN OFFICER OF A CORPORATION]
[Signature] [Signature]
[Address] [Address]
Dated: _____________ Dated:
STATE OF____________________________ )
) ss. (SEAL)
COUNTY OF__________________________ )
The foregoing instrument was acknowledged before me_________ this day_________of by ___________
My Commission Expires____________
Signature of Notary Public
________________________ __________________________________________
Printed Name of Notary Signature of Notary
Version 4/18 Page | 8
CORPORATE PROPERTY OWNER SIGNATURE BLOCK AND ACKNOWLEDGMENT
__________________________________________________
[Insert Company’s or Trust’s Name]
By: __________________________________________________
[Signature of Authorized Officer, or Trustee]
Its: __________________________________________________
[Insert Title]
Dated:
STATE OF______________________)
) ss.
COUNTY OF____________________)
The foregoing instrument was acknowledged before me, this___________ day of _____________ , 20____ by
__________________________________,______ ____________________________________________
[Insert Signor’s Name] [Insert Title]
___________________________________, _________________________________________________an ,
[Name of Company or Trust] [Insert State of Incorporation, if applicable]
and who being authorized to do so, executed the foregoing instrument on behalf of said entity for the
purposes stated therein.
My Commission Expires: ___________________
________________________________________ ______________________________________
Printed Name of Notary Signature of Notary
ALTERNATE: Use the following acknowledgment only when a second company is signing
on behalf of the owner:
STATE OF_________________ )
) ss. (Seal)
COUNTY OF_______________ )
The foregoing instrument was acknowledged before me, this_______ day of ______________ , 20____ by
_________________________________________, who acknowledges himself/herself to be
[Insert Signor’s Name]
____________________________________________ , of _____________________________________
[Title of Office Held] [Second Company]
as _____________________________________ for ________________________________, and who being
[i.e. member, manager, etc] [Owner’s Name]
authorized to do so, executed the foregoing instrument on behalf of said entities for the purposes stated
therein.
My Commission Expires____________
_____________________ _________________________________
Printed Name of Notary Signature of Notary
Version 4/18 Page | 9
ACKNOWLEDGMENT OF INTENT TO USE PROPERTY AS A MEDICAL MARIJUANA FOOD ESTABLISHMENT
(To be completed by all landowners who intend to allow a Off-site cultivation location on their property. Instructions for completing
required information are in bold and brackets below lines. If applicant is a company, corporation, partnership, joint venture, trustee,
etc., please use the corporate signature block and have the notary fill in the notarization section for corporations not individuals.)
TO: Pinal County Community Development
P.O. Box 2973
Florence, AZ 85132
__________________________________________________________________________________________
[Insert Name -- If a Corporation, Partnership or Association, Include State of Incorporation]
hereinafter referred to as “Owner,” is/are the owner(s) of __________________________acres located at
___________________________________________________________________, and further identified
[Insert Address of Property]
as assessor parcel number _____________________________________and legally described as follows:
[Insert Parcel Number]
[Insert Legal Description Here OR Attach as Exhibit A]
Said property is hereinafter referred to as the “Property.”
Owner consents to ’s application for a medical marijuana
[Insert Name of Applicant]
dispensary off-site cultivation location and consents to the issuance of the permit for the stated use on the
Property.
[Individual PROPERTY OWNER signature block and acknowledgment.
DO NOT SIGN HERE IF SIGNING AS AN OFFICER OF A CORPORATION]
[Signature] [Signature]
[Address] [Address]
Dated: _____________ Dated:
STATE OF____________________________ )
) ss. (SEAL)
COUNTY OF__________________________ )
The foregoing instrument was acknowledged before me_________ this day_________of by ___________
My Commission Expires____________
Signature of Notary Public
________________________ __________________________________________
Printed Name of Notary Signature of Notary
Version 4/18 Page | 10
CORPORATE PROPERTY OWNER SIGNATURE BLOCK AND ACKNOWLEDGMENT
__________________________________________________
[Insert Company’s or Trust’s Name]
By: __________________________________________________
[Signature of Authorized Officer, or Trustee]
Its: __________________________________________________
[Insert Title]
Dated:
STATE OF______________________)
) ss.
COUNTY OF____________________)
The foregoing instrument was acknowledged before me, this___________ day of _____________ , 20____ by
__________________________________,______ ____________________________________________
[Insert Signor’s Name] [Insert Title]
___________________________________, _________________________________________________an ,
[Name of Company or Trust] [Insert State of Incorporation, if applicable]
and who being authorized to do so, executed the foregoing instrument on behalf of said entity for the
purposes stated therein.
My Commission Expires: ___________________
________________________________________ ______________________________________
Printed Name of Notary Signature of Notary
ALTERNATE: Use the following acknowledgment only when a second company is signing
on behalf of the owner:
STATE OF_________________ )
) ss. (Seal)
COUNTY OF_______________ )
The foregoing instrument was acknowledged before me, this_______ day of ______________ , 20____ by
_________________________________________, who acknowledges himself/herself to be
[Insert Signor’s Name]
____________________________________________ , of _____________________________________
[Title of Office Held] [Second Company]
as _____________________________________ for ________________________________, and who being
[i.e. member, manager, etc] [Owner’s Name]
authorized to do so, executed the foregoing instrument on behalf of said entities for the purposes stated
therein.
My Commission Expires____________
_____________________ _________________________________
Printed Name of Notary Signature of Notary
Version 4/18 Page | 11
PRINCIPAL OFFICER, BOARD MEMBER AND DISPENSARY IDENTIFICATION LIST
Please list all Principal Officers, Board Members and Dispensary Agents of the non-profit medical marijuana
dispensary. (if there are more than three officers please reproduce this page, each page will need to be
notarized)
Name Title Address Date of Birth
Name Title Address Date of Birth
Name Title Address Date of Birth
I hereby certify that none of the above listed principal officers or board members has served as a principal
officer or board member for a registered non-profit medical marijuana dispensary that has had it registration
certificate revoked or been convicted of one of the following offenses:
i. A violent crime as defined in A.R.S. § 13-901.03(B) that was classified as a felony in the jurisdiction
where the person was convicted;
ii. A violation of state or federal controlled substance law that was classified as a felony in the
jurisdiction where the person was convicted including an offense for which the sentence, any term of
probation, incarceration or supervised release, was completed within the 10 years prior to applying
for the application for the dispensary or an offense involving conduct that would be immune from
arrest, prosecution or penalty under A.R.S. §36-2811 except that the conduct occurred before the
effective date of that statute or was prosecuted by an authority other than the State of Arizona.
(Signature) (Date) (Signature) (Date) (Signature) (Date)
On this day of , 201 , before me personally appeared ,
(name of signor)
,
(name of signor) (name of signor)
State of
)ss. (SEAL)
County of
My Commission Expires____________
Signature of Notary Public
Version 4/18 Page | 12
Pinal County Broadcast Notification Signs:
Zoning, Planned Area Developments, Special Use Permits and Industrial Use Permits Site Posting
Requirements
1. Broadcast signs shall be installed and removed by the applicant
2. Broadcast signs shall be installed 28 days before the Planning Commission hearing
3. Broadcast signs shall remain in place until the Board of Supervisors has made a decision on the case
4. Broadcast signs shall be removed no later than 30 days after the Board of Supervisors has made a
decision on the case
5. Broadcast signs shall be placed adjacent to each road that borders the property, or as determined by
the Planning Manager
6. Broadcast signs can contain more than one case
7. Regular signs, if needed, will be posted by County staff
8. Text on the sign shall meet the specifications shown on page 2 of this document
9. Broadcast sign specifications:
a. 4 Feet Tall by 8 Feet Wide
b. Top of the sign shall be 6 feet above the ground
c. Laminated plywood or MDO board
d. Attached to 2 – 4” by 4” wooden poles
e. All surfaces, including edges shall be painted Sunburst Yellow or approved equivalent
f. Black letters shall be used and shall be sized per the specifications shown below
10. Pinal County staff will place information about Planning Commission and Board of Supervisor hearings
on the Broadcast sign in the designated area
11. Submit the posting affidavit as soon as the sign is installed along with a photograph, any incorrect
information on the sign may result in delay of your case
12. Case description information should be brief but able to convey what the application is for i.e.
Rezoning for a 600 lot single family residential subdivision
Letter Sizes: All Letters Upper and Lower Case Unless Specified
5” BOLD CAPITAL LETTERS
5” Bold Italic Letters
2”
Letters
3” Letters
2” Letters
2” Letters
2” Letters
3” Letters
3” Letters
2” Letters
2” Letters
Version 4/18 Page | 13
Zoning and Planned Area Development Cases:
4 Feet Tall by 8 Feet Wide, Sunburst Yellow or equivalent
Special Use Permit and Industrial Use Permit Cases
4 Feet Tall by 8 Feet Wide
PINAL COUNTY
Public Hearings
PINAL COUNTY
Public Hearings
C
ase Number:
Public Hearing Information
Existing Zoning:
Proposed Zoning:
Acreage:
Case Description:
Applicant Name:
Applicant Phone Number:
Case Information Available at Pinal County Community Development
(520) 866-6442 or www.pinalcountyaz.gov
PINAL COUNTY
Public Hearings
C
ase Number:
Public Hearing Information
Existing Zoning:
Acreage:
Case & SUP Description:
Applicant Name:
Applicant Phone Number:
Case Information Available at Pinal County Community Development
(520) 866-6442 or www.pinalcountyaz.gov
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PROCEDURE AND APPLICATION FOR A PROPOSED SPECIAL USE (Pinal County Government)

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Completed 25 February 2021

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