Medical Marijuana Dispensary Permit Application ...

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Medical Marijuana Dispensary Permit Application

You may apply for one dispensary permit in this application for any of the medical marijuana regions listed below. A separate application must be submitted for each primary dispensary location sought by the applicant. Please see the Medical Marijuana Organization Permit Application Instructions for a table of the counties within each medical marijuana region and the counties in which you are eligible to locate your primary dispensary.

Please check to indicate the medical marijuana region, and specify the county, for which you are applying for a dispensary permit:

Northwest Southwest

Northcentral Southcentral

Northeast Southeast

County 1 (Primary Dispensary Location): Butler County 2 (if applicable): Allegheny County 3 (if applicable):

1 Updated February 1, 2017 ? See Guidance

Pennsylvania Department of Health Medical Marijuana Dispensary Permit Application

Medical Marijuana Dispensary Permit Application

Part A - Applicant Identification and Dispensary Information

(Scoring Method: Pass/Fail) FOR THIS PART, THE APPLICANT IS REQUIRED TO PROVIDE BACKGROUND AND CONTACT INFORMATION FOR THE BUSINESS OR INDIVIDUAL APPLYING FOR A DISPENSARY PERMIT, THE PRIMARY DISPENSARY LOCATION, ALONG WITH ANY SECOND OR THIRD DISPENSARY LOCATIONS THAT ARE BEING SOUGHT UNDER THE APPLICATION.

Section 1 ? Applicant Name, Address and Contact Information Business or Individual Name and Principal Address Business Name, as it appears on the applicant's certificate of incorporation, charter, bylaws, partnership agreement or other legal business formation documents:

Keystone Relief Centers, LLC Other trade names and DBA (doing business as) names:

N/A

Business Address: 301 Grant St., Floor 20, Attn: Jennifer Minter

City: Pittsburgh

State: PA

Phone: 412-562-8444

Fax: 412-562-1041

Zip Code: 15219

Email:

DOH REDACTION

Primary Contact, or Registered Agent for this Application

Name: Jennifer Minter

Address D City: DOHO PhonRe:EDDOHCTI

REDACTION

State: D Fax: 41O2-562-1041

Zip Code: DOH Email: REDA

DOH REDACTION

Section 2 ? Dispensary Information THE APPLICANT IS REQUIRED TO PROVIDE A PRIMARY DISPENSARY LOCATION. THE APPLICANT MAY INCLUDE A SECOND OR THIRD LOCATION UNDER THIS APPLICATION. A SECOND OR THIRD DISPENSARY MAY BE ADDED TO A DISPENSARY PERMIT AT A LATER DATE THROUGH THE FILING OF AN APPLICATION FOR ADDITIONAL DISPENSARY LOCATIONS.

By checking "Yes," you affirm that you possess the ability to obtain in an expeditious manner the right to use sufficient land, buildings and other premises and equipment to properly carry on the activity described in the medical marijuana dispensary permit application, and any proposed location for a dispensary.

Yes No

Primary Dispensary Location (please indicate dispensary name as you would like it to appear on the dispensary permit)

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Pennsylvania Department of Health Medical Marijuana Dispensary Permit Application

Facility Name: Keystone Relief Centers- Jackson's Pointe

Address: corner of Jackson Land and Jackson Pointe Court

City: Zelienople

State: PA Zip Code: 16063

County: Butler

Municipality: Jackson Township

PLEASE PROVIDE A DESCRIPTION OF THE PUBLIC ACCESS TO THE DISPENSARY LOCATION, INCLUDING ANY LOCAL PUBLIC

TRANSPORTATION THAT MAY BE AVAILABLE:

The Butler County site, located on Jackson Lane in Jackson Township, is 1.473 acres including a ~7,500 square foot to-be-constructed build-to-suit building. The build-to-suit development will be a singlestory building on a single lot and will be ADA compliant. The site is private and the build-to-suit development will feature brand new, comfortable interiors, as well as, a well-lit and secure parking lot.

Located adjacent to Interstate 79, Exit 83 (Evans City) and Perry Highway (U.S. Route 19), the site is directly accessible from the most densely populated areas of the county. The site has vehicular access from Jackson's Lane.

The site is centrally located between the Cranberry, Evans City, and Zelienople neighborhoods. Nearby services, within a 5-mile radius, include 15 grocery stores, 16 convenience stores, 13 hotels, over 35 restaurants, and dozens of shops in the Streets of Cranberry center, Cranberry Gardens Plaza, and Cranberry Mall. Also within a 5-mile radius, the site is conveniently located near many healthcare services including Allegheny Women's Health, Absolute Primary Care ? UPMC, Cranberry Township VA Outpatient Clinic, and UPMC Passavant ? Cranberry.

Transportation Vehicular County Access: The site is located in the southeastern portion of Butler County very close to the densely populated Cranberry Township. The site location is conveniently located adjacent to a number of major roadways, making it very easily accessible to the entire county (please see Neighborhood Access section for more detail).

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Pennsylvania Department of Health Medical Marijuana Dispensary Permit Application Site Access: The site has vehicular access from both northbound and southbound traffic on Perry Highway (U.S. Route 19). Butler County / Vehicular Site Access Map (Source: Google Maps)

The following vehicular traffic will have direct access to the site from Perry Highway (U.S. Route 19): Personal automobiles Taxis Uber

Neighborhood Access: The site is located in the southwestern portion of the county and can be conveniently accessed by a number of major roadways. U.S. Route 19 and Interstate 79 have the most direct access to the site and run north to south along the western border of the county, cutting through the following major areas: Portersville, Zelienople, Harmony, and Cranberry Township. Pennsylvania Route 8, which connects to U.S. Route 19, giving it direct access to the site, runs north to south in the center of the county and connects the site to the City of Butler, the largest city in the county and also the county seat. Townships on the eastern side of the county access the site via Pennsylvania Route 68 which connects to U.S. Route 19 and runs southwest to northeast

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