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(4) State whether any applicant, or any of the individuals identified in the appli- <br />cation pursuant to subsection (b) hereof, has had a previous license under this <br />chapter or other similar regulation of another jurisdiction denied, suspended or <br />revoked, including the name and location of the medical marijuana dispensary <br />for which the permit was denied, suspended or revoked, as well as the date of <br />the denial, suspension or revocation; and state whether the applicant has been a <br />partner in a partnership or an officer, director or 10 percent or greater owner of a <br />corporation licensed under this chapter whose license has previously been de- <br />nied, suspended or revoked, including the name and location of the business for <br />which the permit was denied, suspended or revoked as well as the date of denial, <br />suspension or revocation. <br />(5) State whether any applicant, or any of the individuals identified in the appli- <br />cation pursuant to subsection (b) hereof, holds any other licenses under this <br />chapter or other similar regulation from this or another jurisdiction and, if so, the <br />names and locations of such other licensed businesses. <br />(6) State the location of the proposed medical marijuana dispensary, including a <br />legal description of the property, street address, and telephone number(s), if any. <br />(7) State the mailing address and residential address of each applicant and each <br />person signing the application. <br />(8) Submit a current, valid retail dispensary license or provisional dispensary li- <br />cense issued to the applicant by the state board of pharmacy under the provi- <br />sions of R.C. Chapter 3796 and the regulations promulgated thereunder, or evi- <br />dence that the applicant has made application for such a license or provisional <br />license to the state board of pharmacy. <br />(9) Submit a security plan for review and approval by the Chief. The security <br />plan shall be on a form or in a manner prescribed by the Chief and shall include, <br />at a minimum, a lighting plan that identifies how the interior, fagade, adjoining <br />sidewalks, parking areas and immediate surrounding areas of the dispensary will <br />be illuminated and how the lighting will deflect light away from adjacent prop- <br />erties; and an identification of operable cameras, alarms, security guards and <br />other security measures to be present on the premises whether during or outside <br />business hours. The security plan should address the applicant's use of off - street <br />parking and proposed use of armed security guards, video surveillance and door, <br />building and parking lot security as appropriate. The applicant shall supply all <br />additional information requested by the Chief necessary for the Chief to evaluate <br />the security plan. <br />(10) State the driver's license number and Social Security number of each ap- <br />plicant who is a natural person and each person signing the application, or, for <br />an applicant that is not a natural person, the applicant's federally issued tax iden- <br />tification number. <br />(11) Submit proof that each applicant who is a natural person is at least 18 years <br />old. <br />(12) Submit a sketch or diagram showing the configuration of the premises of <br />the medical marijuana dispensary. The diagram shall also designate the place at <br />which the dispensary license will be conspicuously posted, if issued. The sketch <br />or diagram need not be professionally prepared, but it must be drawn to a desig- <br />nated scale or drawn with marked dimensions of the interior of the premises to <br />an accuracy of plus or minus six inches. <br />