CITY OF SURREY MEDICAL MARIJUANA PRODUCTION LICENSE APPLICATION FORM

			CITY OF SURREY MEDICAL MARIJUANA PRODUCTION LICENSE APPLICATION FORM
Personal-Use      License				Personal Use      Production License			Designated-Person      Production License
Applicant Name
Applicant Address of Residence
City				Province				Postal Code
Phone No.       (       )                     -					Cell No.           (       )                     -
Cultivation Information
Cultivation Address                                                                                     Zoning
City				Province				Postal Code
Personal Use Licensee
Name	Surname			First Name		Middle Name				Mr.    Mrs.
										Ms.   Dr.
Address											Unit No.
City				Province				Postal Code
Phone No.     (       )           -					Cell No.     (       )               -
MMAR Registration No.                           Date of Issue                       Date of Expiry       Number of Plants Permitted on License:             Amount of  Marijuana Permitted to be Stored:
PLEASE NOTE! Medical Marihuana Production License will only be issued for non-dwelling buildings that are situated within the following Agricultural or Horticultural permitted Zoning areas: A1 – General Agriculture Zone                                              RA – One Acre Residential  ** A2 – Intensive Agriculture Zone                                            RH -  Half Acre Residential ** IA – Agro-Industrial Zone ** Property must be 2 hectares ( 5 acres)or larger before agricultural or horticultural use permitted

I hereby make application for a license in accordance with all the information as above stated and declare that this is a true and correct statement and I further agree to comply with all the relevant By-Laws of THE CITY OF SURREY.
Signature		Date

TURN OVER FOR APPLICATION CHECK LIST

Application Check List    2 Copies of current photograph of Applicant    Photocopy of Health Canada License and any related regulations or restrictions    Dimensional floor plan of Medical Marijuana Cultivation Facility (must be enclosed within a non-dwelling         building.    Ventilation plan (must include how system prevents any offensive odour from leaving building)    Prevention of harmful mould growth plan    Remediation plan    Security and lighting plan (must include monitored alarm system)    Electrical, lighting & equipment plan including electrical distribution plan & demand load    Storage plan    Medical Marijuana disposal plan (must include how non-used plant material is disposed of) Designated-Person Production License (Additional Check List)    Delivery plan (to patients)    Security camera use and placement plan    Neighbourhood responsibility plan    Medical Marijuana disposal plan    Criminal Record check        (NOTE: any previous convictions for offences under the Controlled Drugs & Substances Act may result in    this application being refused)    Written permission from property owner (if tenant is holder of license)

Applicable Bylaws

·        Cultivation and Production of Medical Marijuana Bylaw, No. 17410

·        Zoning Bylaw, No. 12000

·        Controlled Substance Property Bylaw, 2006, No. 15820

·        Surrey Electrical Safety Bylaw, 2004, No. 15596

·        Surrey Plumbing Bylaw, 1981, No. 6569

·        Surrey Building Bylaw, 1987, No. 9011