A.    Each application shall set forth or incorporate by reference the following information in a standard form adopted by the board of supervisors:

    1.    Address of the proposed dispensary and the name and address of the owner of the premises.

    2.     The full name, date of birth, social security number, present address and telephone number of the applicant.

    3.    The address to which notice of action on the application is to be mailed.

    4.    All residential addresses of the applicant for the five years immediately prior to the date of the application.

    5.    Written proof that the applicant is eighteen (18) years of age or older (i.e., California driver’ s license, California identification card or birth certificate).

    6.     The height and weight and the color of eyes and hair of the applicant.

    7.     Photographs of the applicant for identification purposes to be taken by the sheriff.

    8.    The names and addresses of all businesses operated by and the employment of the applicant for the five years immediately prior to the date of the application.

    9.    The address of any dispensaries that had previously been operated by the applicant and a statement of whether the authorization for any such operation had been revoked or suspended and, if so, the reason therefor.

    10.    The names and telephone numbers of the person or persons to be regularly engaged in the operation of the proposed dispensary, whether an employee, volunteer or contractor. The application shall also identify those persons, including telephone numbers (i.e., emergency contact), having management and supervisory responsibilities for the proposed dispensary. Every person listed as owner, manager, supervisor or employee must submit fingerprints and other necessary information for a background check to the Alameda County sheriff’ s office, and be photographed for identification purposes. In addition, any new employees, independent contractors, other persons and/or volunteers who will work at the proposed medical marijuana dispensary must submit their information to the sheriff’ s office within five days prior to their employment.

    11.    A description of the proposed security arrangements for insuring the safety of persons and protection of the premises from theft.

    12.    A sketch or diagram showing the interior configuration of the premises, including a statement of the total floor area occupied by the dispensary. The sketch or diagram need not be professionally prepared, but must be drawn to a designated scale or drawn with marked dimensions of the interior of the premises to an accuracy of plus or minus twelve (12) inches.

    13.    A description of external appearance of the dispensary, including a precise depiction of any signage.

    14.    A description of products to be sold or dispensed by the dispensary.

    15.    The mission statement of the dispensary with respect to meeting the medical needs of patients in its area, as delineated by subsection D of Section 6.108.030.

    16.    A description of the methods by which the applicant will mitigate any potentially adverse impacts, such as loitering or noise, on surrounding property owners.

    17.    Authorization for the county, its agents and employees to seek verification of the information contained in the application.

    18.    Written certification that the applicant has reviewed and understands and accepts the standard conditions that are set forth in Section 6.108.120.

    19.    Certification, under penalty of perjury, that all the information contained in the application is true and correct.

    20.    A statement by the applicant that it has the ability to comply with all laws regulating businesses in the state of California and that it shall maintain compliance during the term of the permit.

    B.    The filing of an application shall be deemed complete upon the submission of an application in conformance with this section and payment of the application fees required by Section 6.108.070.

    C.    An application may be reviewed and copied by any member of the public in accordance with the California Public Records Act. (Ord. 2005-52 § 2 (part): Ord. 2005-25 § 2 (part))

6.108.060